Cephalic Arch Stenosis: Mechanisms and Management Strategies

Daoui, Rachid; Asif, Arif

doi:10.1016/j.semnephrol.2012.10.004

Cited by 33 publications

(44 citation statements)

References 20 publications

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“…13 Most of the outflow vein stenoses identified in our series occurred at the cephalic arch, which mirrors other published reports. 16,17 These stenotic lesions were readily detected using ultrasound imaging and physical finding of pulsatility. All of the venous stenoses detected postoperatively were recurrent in nature, except for one.…”

Section: Discussionmentioning

confidence: 99%

Staple aneurysmorrhaphy to salvage autogenous arteriovenous fistulas with aneurysm-related complications

Tumbaga

Aka

et al. 2015

Journal of Vascular Surgery

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Our experience with staple aneurysmorrhaphy shows that it is an effective, safe, and durable procedure to preserve a functioning autogenous AVF with complicated aneurysmal degeneration. Key principles are to reduce the vein to normal adjacent diameter and to provide healthy skin coverage. The remodeled AVF has a low aneurysm recurrence rate and maintains the beneficial properties of superior patency and low infection. It is important to aggressively monitor for and treat proximal outflow venous stenoses to prevent aneurysm recurrence. The surgery can be done safely under local anesthesia in selected patients.

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Section: Discussionmentioning

confidence: 99%

Staple aneurysmorrhaphy to salvage autogenous arteriovenous fistulas with aneurysm-related complications

Tumbaga

Aka

et al. 2015

Journal of Vascular Surgery

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“…Most commonly, neointimal hyperplasia after AVF creation is found near the anastomotic site but can also be observed in other segments of the draining vein . In contrast to restenosis associated with preocclusive atherosclerotic arteries after angioplasty and stenting, the vessels involved are in many cases free from atherosclerotic plaques . Histologically, the neointimal lesions in AVFs consist of proliferating and migrating vascular cells that are presumed to be of many different origins including mature VSMCs, adventitial progenitor cells, or bone marrow stem cells .…”

Section: Introductionmentioning

confidence: 99%

Dual Function for Mature Vascular Smooth Muscle Cells During Arteriovenous Fistula Remodeling

Jourd’heuil

Xue

Conti

et al. 2017

JAHA

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BackgroundThe arteriovenous fistula (AVF) is the preferred form of hemodialysis access for patients with chronic kidney disease. However, AVFs are associated with significant problems including high incidence of both early and late failures, usually attributed to inadequate venous arterialization and neointimal hyperplasia, respectively. Understanding the cellular basis of venous remodeling in the setting of AVF could provide targets for improving AVF patency rates.Methods and ResultsA novel vascular smooth muscle cell (VSMC) lineage tracing reporter mouse, Myh11‐Cre/ERT2‐mTmG, was used to track mature VSMCs in a clinically relevant AVF mouse model created by a jugular vein branch end to carotid artery side anastomosis. Prior to AVF surgery, differentiated medial layer VSMCs were labeled with membrane green fluorescent protein (GFP) following tamoxifen induction. Four weeks after AVF surgery, we observed medial VSMC layer thickening in the middle region of the arterialized vein branch. This thickened medial VSMC layer was solely composed of differentiated VSMCs that were GFP+/MYH11+/Ki67−. Extensive neointimal hyperplasia occurred in the AVF region proximal to the anastomosis site. Dedifferentiated VSMCs (GFP+/MYH11−) were a major cellular component of the neointima. Examination of failed human AVF samples revealed that the processes of VSMC phenotypic modulation and intimal hyperplasia, as well as medial VSMC layer thickening, also occurred in human AVFs.ConclusionsWe demonstrated a dual function for mature VSMCs in AVF remodeling, with differentiated VSMCs contributing to medial wall thickening towards venous maturation and dedifferentiated VSMCs contributing to neointimal hyperplasia. These results provide valuable insights into the mechanisms underlying venous adaptations during AVF remodeling.

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“…Можно условно выделить четыре характерные локализации стеноза: артериовенозный или артериопротезный анастомоз, стеноз юкстаанастомотического сегмента фистульной вены, стеноз фистульной вены на протяжении («функционального» сегмента), стеноз «плечевой дуги» [5]. В зависимости от типа сформированной АВФ стенотические поражения могут возникать в любом месте участвующих в доступе сосудов -от артерии (артериовенозного или артериопротезного анастомоза) до центральной вены [28,29]. Как мы упоминали выше, при дистальной АВФ стенозы встречаются несколько чаще, чем при проксимальных.…”

Section: распространенность стенозов периферических отделов фистульноunclassified

Open and endovascular surgery for stenosis of the peripheral regions of arteriovenous fistula

Карданахишвили

Зулькарнаев

2019

Bûll. sib. med.

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Vascular access is the cornerstone of hemodialysis. With vascular access dysfunction, the results of treatment of patients with stage 5 chronic kidney disease significantly deteriorate. One of the most common causes of vascular access failure is peripheral venous stenosis. Despite the variety of initiating factors, the morphological substrate of stenotic damage to the arteriovenous fistula (or arteriovenous anastomosis) in most cases is neointimal hyperplasia. Stenotic lesions of the arterivenous fistula are strongly associated with an increased risk of thrombosis and loss of vascular access. There are 4 typical localizations of stenosis: arteriovenous or arteriograft anastomosis, stenosis of the juxta-anastomotic segment of the fistula, stenosis of the functional segment of the fistula, and stenosis of the cephalic arc.The most common indication for surgical treatment is vascular access failure; less common indications are clinical symptoms of venous insufficiency.There are various methods of open reconstruction of the stenotic segment of the fistula vein: resection, prosthetics with a synthetic vascular graft, prosthetics or plastic repair of the autologous vein wall, complete or partial drainage of the prestenotic segment of the vein, etc. Currently an alternative method of stenosis repair using endovascular interventions is gaining popularity. In contrast to central vein stenosis, where endovascular interventions are the gold standard, in peripheral vein stenosis it is only an adjuvant method. Complications of endovascular interventions are extremely rare.Despite the fact that endovascular interventions have almost absolute probability of technical success, the primary patency is not high and is about 50% in six months. The use of bare stents is not accompanied by an increase in primary patency. The use of stent-grafts can increase the primary patency, especially in the plastic repair of challenging stenoses of the graft-vein anastomosis or cephalic arch.Many issues related to endovascular interventions remain unresolved, which requires further research.

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Cephalic Arch Stenosis: Mechanisms and Management Strategies

Cited by 33 publications

References 20 publications

Staple aneurysmorrhaphy to salvage autogenous arteriovenous fistulas with aneurysm-related complications

Staple aneurysmorrhaphy to salvage autogenous arteriovenous fistulas with aneurysm-related complications

Dual Function for Mature Vascular Smooth Muscle Cells During Arteriovenous Fistula Remodeling

Open and endovascular surgery for stenosis of the peripheral regions of arteriovenous fistula

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