True degenerative aneurysms of permanent vascular access. Etiology, pathogenesis and clinical characteristics of patients
AbstractBackground. The frequency of development of true aneurysms of native permanent vascular access according to the literature ranges from 5 to 40% of patients on program hemodialysis. Current clinical guidelines contain neither a clear definition of this notion nor specific treatment algorithms for this pathology.
Objective. The purpose of this study was to determine the prevalence of true degenerative aneurysms of a permanent vascular access (PVA), possible etiologic factors of their occurrence, clinical peculiarities of the course of the disease, and the most significant syndromes in this pathology of PVA.
Patients and methods. The study included a total of 219 patients undergoing program dialysis through a native arteriovenous fistula. The patients’ age ranged from 24 to 83 years (mean 59.1±0.9 years). There were 114 males and 105 females. The mean time on program hemodialysis was 60.7±3.9 (1–360) months. The average duration of the relevant vascular access functioning amounted to 45.3±3.1 months (1–312). An “aneurysm of the permanent vascular access” was defined as the size of the native vascular access exceeding 2.0 cm, i. e., a twofold increase in the median diameter of the arteriovenous fistula (AVF) in the study group (1.0).
Results and discussion. Aneurysms of the native permanent vascular access were detected in 11.8% of patients. No correlation between the frequency of aneurysm development and hereditary pathology was revealed. 54.5% of the patients diagnosed with PVA aneurysms had pathology of outflow tracts, with a peculiarity that catheterization of homolateral central veins was recorded 2.1 times more often in their medical histories. The duration of AVF function without aneurysms was 2.7 times shorter than in the group with aneurysms (36±3.9 vs. 96±9.7 months, p=0.000).
Volumetric blood flow through the AVF (QA AVF, ml/min) was 1.7 times higher in patients with aneurysms, and shunt cardiac fraction (QA to minute cardiac volume ratio – SCF) was 1.8 times higher (p<0.05). Abnormal SCF (greater than 0.3) was present in 80.0% of patients with aneurysms and only in 15.7% of patients without aneurysms (p<0.001). During a 12-month follow-up, these indices had significant negative dynamics, and the rate of change in these indices had a significant positive correlation with the diameter of the AVF. Progression of high-flow syndrome is associated with potential development of chronic heart failure and may be an indication for surgical correction of true degenerative aneurysms of the permanent vascular access.
Conclusion. One of the most significant clinical syndromes accompanying PVA degenerative aneurysms is high AVF flow, potentially leading to heart failure. This pathology progresses over time, and the rate of its development correlates with the diameter of the native AVF.
Funding. The study had no financial support.
Conflict of interest. The authors declare no conflicts of interest.
Authors’ contribution. Study conception and design – Maksimov A.V., Feiskhanov A.K., Grigoryan D.V.; data collection and handling – Maksimov A.V., Grigoryan D.V., Akhundova E.N.; statistical processing – Maksimov A.V., Grigoryan D.V.; draft manuscript preparation – Maksimov A.V., Grigoryan D.V.; manuscript revision – Maksimov A.V., Feiskhanov A.K., Poberezhnyi V.Ya.
For citation: Maksimov A.V., Feiskhanov A.K., Grigoryan D.V., Akhundova E.N., Poberezhnyi V.Ya. True degenerative aneurysms of permanent vascular access. Etiology, pathogenesis and clinical characteristics of patients. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2024; 30 (2): 72–9. DOI: https://doi.org/10.33029/1027-6661-2024-30-2-72-79
Keywords: program hemodialysis; permanent vascular access; true aneurysms
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