medjournalМедицинский журналMedical Journal1818-426XБелорусский государственный медицинский университет10.51922/1818-426X.2026.3.57medjournal-450Research ArticleОБЗОРЫREVIEWSСовременные представления о профилактике тромбозов артериовенозных фистул у пациентов на программном гемодиализеCURRENT PERSPECTIVES ON THROMBOSIS PREVENTION IN ARTERIOVENOUS FISTULAS IN PATIENTS UNDERGOING HEMODIALYSISШейденковВ. А.ShaidziankouU. A.

Минск

Minsk

ГромыкоВ. Н.HramykaV. N.

Минск

Minsk

УЗ «1-я городская клиническая больница»Беларусь1 st City Clinical HospitalBelarusУО «Белорусский государственный медицинский университет»БеларусьBelarusian State Medical UniversityBelarus202624072026035763Copyright © Шейденков В.А., Громыко В.Н., 20262026Шейденков В.А., Громыко В.Н.Shaidziankou U.A., Hramyka V.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://medjournal.ejournal.by/jour/article/view/450

В последние годы отмечается устойчивый рост числа пациентов с 5-ой стадией хронической болезнью почек, нуждающихся в почечно-заместительной терапии (ПЗТ). Для проведения ПЗТ методом программного гемодиализа (ПГД) необходимо обеспечить пациенту надежный и длительно функционирующий сосудистый доступ. «Золотым» стандартом сосудистого доступа для ПГД является артериовенозная фистула (АВФ). Ее формирование обеспечивает адекватный кровоток, низкую частоту инфекционных осложнений и лучшую выживаемость пациентов по сравнению с другими вариантами сосудистого доступа – центральными венозными катетерами, сосудистыми графтами. Сохранность АВФ напрямую определяют эффективность диализной терапии и выживаемость пациентов.

Цель

Цель. Систематизировать современные представления о патогенезе, факторах риска и методах профилактики тромбозов АВФ у пациентов на программном гемодиализе.

Материалы и методы

Материалы и методы. Проведён обзор литературы за 2010–2025 гг. с использованием баз PubMed, Scopus, Web of Science и Google Scholar. В анализ были включены оригинальные исследования, метаанализы, клинические рекомендации и консенсусы, посвящённые дисфункции АВФ.

Результаты

Результаты. Тромбозы АВФ остаются ведущей причиной их дисфункции, обусловленной множеством факторов, включая гиперплазию интимы, воспаление, метаболические нарушения и хирургические аспекты. Определены значимые демографические, анатомо-функциональные и лабораторные предикторы осложнений. Показана прогностическая значимость предоперационного УЗИ-картирования, оценки сосудистого русла и состояния пациента. Фармакологическая профилактика остаётся предметом дискуссии. Перспективными направлениями являются применение аналогов простагландина Е1 и простациклина, а также комплексный подход к стратификациии рисков.

Заключение

Заключение. Профилактика тромбозов АВФ требует мультидисциплинарного подхода, включающего предоперационное планирование, контроль факторов риска и дальнейшие исследования новых терапевтических стратегий.

In recent years, there has been a steady increase in the number of patients with stage 5 chronic kidney disease who require renal replacement therapy (RRT). It is essential to provide the patient with reliable and long-term functioning vascular access to deliver RRT by means of maintenance hemodialysis (HD). The “gold standard” for vascular access in HD is the arteriovenous fistula (AVF). Its creation ensures adequate blood flow, a lower incidence of infectious complications, and improved patient survival compared with other options, such as central venous catheters and vascular grafts. The preservation of AVF function directly determines the effectiveness of dialysis therapy and patient survival.

Objective

Objective. To present and summarize current understanding of the pathogenesis, risk factors, and preventive strategies for AVF thrombosis in patients undergoing hemodialysis.

Materials and Methods

Materials and Methods. A literature review was conducted covering the years 2010–2025 using the PubMed, Scopus, Web of Science, and Google Scholar databases. The analysis included original studies, meta-analyses, clinical guidelines, and expert consensus documents addressing AVF dysfunction.

Results

Results. AVF thrombosis remains a leading cause of vascular access failure, driven by multiple mechanisms including intimal hyperplasia, inflammation, metabolic disturbances, and surgical factors. Key demographic, anatomical, and laboratory predictors of complications were identified. The prognostic value of preoperative ultrasound vessel mapping and comprehensive patient assessment was demonstrated. Pharmacological prevention remains controversial. Promising approaches include the use of prostaglandin E1 and prostacyclin analogs, along with individualized risk stratification strategies.

Conclusion

Conclusion. Effective prevention of AVF thrombosis requires a multidisciplinary approach encompassing preoperative planning, risk factor control, and further clinical research into novel therapeutic options.

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The authors declare that there are no conflicts of interest present.