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3 . 2026

Identifying predictors of central vein post-angioplasty 6-month patency in dialysis patients

Abstract

Background. Balloon angioplasty is the first-line treatment for dialysis access dysfunction caused by central vein lesions. Unfortunately, in some cases, restenosis occurs within 6 months. Identifying predictors of unfavorable outcomes will optimize the intervention technique and improve long-term patency. Creating a prognostic tool for assessing the risk of early recurrence will allow for additional focus on the most vulnerable patient group.

Objective. To determine factors influencing the 6-month primary patency of central veins after isolated balloon angioplasty in hemodialysis patients.

Patients and methods. This retrospective cohort study included a total of 80 patients who underwent central vein balloon angioplasty between 01.07.2020 and 01.07.2024. The inclusion criteria were as follows: symptomatic central vein stenosis/occlusion, mature vascular access, and no prior interventions on the target vein. The primary endpoint was vein patency at 6 months. The patients were divided into two groups based on 6-month patency. Predictors of early restenosis were analyzed. Statistical analysis included univariate and multivariate methods (Firth-penalized logistic regression), ROC analysis, multi-component model validation, and bootstrap validation.

Results. The following key predictors were identified: residual stenosis (OR 0.94; 95% CI 0.88–0.99; p=0.012), balloon oversize (OR 1.08; 95% CI 1.01–1.17; p=0.014), the square of balloon oversize (OR 0.997; 95% CI 0.993–0.999; p=0.002), and white blood cell count (OR 0.76; 95% CI 0.56–0.996; p=0.046). The obtained prognostic model (AUC 0.882; 95% CI 0.809–0.955) demonstrated high discriminative ability and good calibration (p=0.068). Model stability analysis and bootstrap validation were performed. A quadratic dependence of patency on balloon catheter oversize was demonstrated for the first time, indicating the existence of its optimal value. Based on the model, a formula for quantifying the individual probability of 6-month patency is provided.

Conclusion. Residual stenosis is the most significant risk factor: each additional 1% is associated with approximately a 6% decrease in the odds of 6‑month patency. Optimization of the balloon catheter diameter and achieving minimal residual stenosis are key elements for improving the balloon angioplasty technique. Leukocytosis is associated with increased odds of early restenosis, which may reflect the role of systemic inflammation.

Keywords:balloon angioplasty; central veins; hemodialysis; predictors; restenosis; patency; prognostic model

Authors’ contribution. Study conception and design – Sysoev V.M., Abugov S.A.; data collection and handling – Shaykhutdinov B.I., Sysoev V.M., Abugov S.A.; statistical processing – Shaykhutdinov B.I.; draft manuscript preparation – Shaykhutdinov B.I.; manuscript revision – Shaykhutdinov B.I., Abugov S.A.

For citation: Shaykhutdinov B.I., Sysoev V.M., Abugov S.A. Identifying predictors of central vein post-angioplasty 6-month patency in dialysis patients. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2026; 32 (3): 78–86. DOI: https://doi.org/10.33029/1027-6661-2026-32-3-78-86

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CHIEF EDITOR
CHIEF EDITOR
Yuri V. Belov
Academician of the Russian Academy of Sciences Doctor of Medical Sciences, Professor, President of the Russian Society of Angiologists and Vascular Surgeons

 

In accordance with the decision of the Presidium of the Russian Society of Angiologists and Vascular Surgeons, the journal "Angiology and Vascular Surgery" will be named after Academician A.V. Pokrovsky starting from No. 2/2022.

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