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Abstract-In the present study, we examined the expression of regulators of bone formation and osteoclastogenesis in human atherosclerosis because accumulating evidence suggests that atherosclerotic calcification shares features with bone calcification. The most striking finding of this study was the constitutive immunoreactivity of matrix Gla protein, osteocalcin, and bone sialoprotein in nondiseased aortas and the absence of bone morphogenetic protein (BMP)-2, BMP-4, osteopontin, and osteonectin in nondiseased aortas and early atherosclerotic lesions. When atherosclerotic plaques demonstrated calcification or bone formation, BMP-2, BMP-4, osteopontin, and osteonectin were upregulated. Interestingly, this upregulation was associated with a sustained immunoreactivity of matrix Gla protein, osteocalcin, and bone sialoprotein. The 2 modulators of osteoclastogenesis (osteoprotegerin [OPG] and its ligand, OPGL) were present in the nondiseased vessel wall and in early atherosclerotic lesions. In advanced calcified lesions, OPG was present in bone structures, whereas OPGL was only present in the extracellular matrix surrounding calcium deposits. The observed expression patterns suggest a tight regulation of the expression of bone matrix regulatory proteins during human atherogenesis. The expression pattern of both OPG and OPGL during atherogenesis might suggest a regulatory role of these proteins not only in osteoclastogenesis but also in atherosclerotic calcification. (Arterioscler Thromb Vasc Biol.

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Digital ischemia in dialysis patients due to arteriovenous fistulas (AVF) is a rare condition, occurring in 4% of patients. The etiology is different from lower limb ischemia. Blood shunting through the AVF may cause stealing of blood and hypoperfusion in distal tissues, leading to pain, discolorisation and ulcers. High-flow AVFs have greater risk on ischemia than normal flow AVFs, however combined with peripheral arteriosclerotic disease the latter may also leads to ischemia. A non-invasive and angiographic diagnosis is of importance to determine treatment options. Augmentation of arterial inflow by interventional techniques and/or AVF bloodflow-reducing surgical procedures may eliminate pain and heal ulcers. The best results are obtained by bypassing the arteriovenous anastomotic site and interruption of steal phenomenon by ligation of the artery distal to the AV anastomosis.

Although, the autogenous RCAVF is considered to be the primary choice for vascular access, this meta-analysis indicates a high primary failure rate and only moderate patency rates at 1 year of follow-up.

This study showed that the BH method is a valuable technique with few complications like haematoma, aneurysm formation and the need for interventions. However, the infections induced by the BH method should not be underestimated. This underlines the importance of an aseptic and correct technique of the buttonhole procedure.

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