Effect of Inflow Arterial Calcification on Arteriovenous Fistula Maturation

Kim, Suh Min; Jung, In Mok; Kim, Dae-Hwan; Lee, Jung Pyo; So, Young

doi:10.1016/j.avsg.2018.10.057

Cited by 10 publications

(12 citation statements)

References 29 publications

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“…In some patients with advanced chronic kidney disease, inflow arterial calcification already exists before the AVF is created surgically. Such preexisting calcification of the inflow artery negatively correlated with the future AVF flow volume 40 . Large elastic, medium‐sized muscular arteries and arterioles are susceptible to calcification.…”

Section: Discussionmentioning

confidence: 97%

“…Such preexisting calcification of the inflow artery negatively correlated with the future AVF flow volume. 40 Large elastic, medium-sized muscular arteries and arterioles are susceptible to calcification. Contrarily, veins hardly undergo calcification unless arterialized after bypass surgery or AVF creation 7 ; thus, it makes sense that AVF calcification is a common complication of dialysis patients.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Mechanical and chemical cues synergistically promote human venous smooth muscle cell osteogenesis through integrin β1‐ERK1/2 signaling: A cell model of hemodialysis fistula calcification

Yang

Chang

et al. 2021

The FASEB Journal

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Arteriovenous fistula (AVF) is the vascular access of choice for renal replacement therapy. However, AVF is susceptible to calcification with a high prevalence of 40%–65% in chronic hemodialysis patients. Repeated needle puncture for hemodialysis cannulation results in intimal denudation of AVF. We hypothesized that exposure to blood shear stress in the medial layer promotes venous smooth muscle cell (SMC) osteogenesis. While previous studies of shear stress focused on arterial‐type SMCs, SMCs isolated from the vein had not been investigated. This study established a venous cell model of AVF using the fluid shear device, combined with a high phosphate medium to mimic the uremic milieu. Osteogenic gene expression of venous SMCs upon mechanical and chemical cues was analyzed in addition to the activated cell signaling pathways. Our findings indicated that upon shear stress and high phosphate environment, mechanical stimulation (shear stress) had an additive effect in up‐regulation of an early osteogenic marker, Runx2. We further identified that the integrin β1‐ERK1/2 signaling pathway was responsible for the molecular basis of venous SMC osteogenesis upon shear stress exposure. Mitochondrial biogenesis also took part in the early stage of this venopathy pathogenesis, evident by the up‐regulated mitochondrial transcription factor A and mitochondrial DNA polymerase γ in venous SMCs. In conclusion, synergistic effects of fluid shear stress and high phosphate induce venous SMC osteogenesis via the ERK1/2 pathway through activating the mechanosensing integrin β1 signaling. The present study identified a promising druggable target for reducing AVF calcification, which deserves further in vivo investigations.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Mechanical and chemical cues synergistically promote human venous smooth muscle cell osteogenesis through integrin β1‐ERK1/2 signaling: A cell model of hemodialysis fistula calcification

Yang

Chang

et al. 2021

The FASEB Journal

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“…10,19 Additionally, the less compliant vessels may have reduced flow, predisposing to partial or total flap necrosis. 20,21 The increased ischemia time associated with anastomotic revisions, which is better tolerated in routine free tissue transfer, may be sufficient in hypercoagulable patients to cause refractory microvascular thrombosis. Early anticoagulation in patients with only pathological intraoperative findings may prevent unnecessary anticoagulation in patients who are not at a significantly increased risk of flap failure.…”

Section: Discussionmentioning

confidence: 99%

Does Anticoagulation Improve Flap Outcomes in Hypercoagulable Patients? A Systematic Review

Kotamarti

Shiah

Rezak

et al. 2019

J reconstr Microsurg

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Background Despite improvements in microsurgical techniques, hypercoagulable patients remain a reconstructive challenge. Thrombophilias are a relatively common problem with potentially catastrophic results including free flap loss. The aim of this study was to assess the available literature on free tissue transfer in patients with known hypercoagulability to develop recommendations for management. Methods A systematic review of the PubMed, EBSCO, and Cochrane databases was performed in June 2018. Inclusion criteria were assessment of outcomes of free tissue transfer in patients with established hypercoagulability. Exclusion criteria were review articles, case reports, and studies lacking detailed discussion of anticoagulation regimens and surgical outcomes. Data collected included the number of hypercoagulable patients, anticoagulation regimens, thrombotic complications, flap success, and bleeding complications. Statistical analysis was performed using independent samples t-tests. Results Of 147 total results, four articles were included for analysis. One relevant article published after search completion was included. In total, 185 free tissue transfers were performed in 155 thrombophilic patients. Anticoagulation regimens varied widely but often included intraoperative continuous heparin, with or without additional bolus, followed by postoperative and outpatient anticoagulation. Hypercoagulable patients often developed late postoperative thromboses. Of the intraoperative thromboses, 36.4% were successfully salvaged. No flaps with postoperative thrombosis were salvaged. Preemptive therapeutic anticoagulation improved outcomes but increased the bleeding risk. Conclusion Free tissue transfer may be successful in hypercoagulable patients. High-risk patients identified preoperatively should receive therapeutic anticoagulation initiated intraoperatively unless contraindicated. Salvage after postoperative thrombosis is poor. Ultimately, the benefits of free tissue transfer must be considered with the potential morbidity of bleeding complications on a case-by-case basis when developing a reconstructive plan. Initiating anticoagulation based on the presence of intraoperative risk factors may prevent unnecessary intervention.

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“…Therefore, the immaturation of AVF in these patients leads to failure, and insufficient lumen causes deficient blood flow; thus, it is not used in treating dialysis. It is challenging to create vascular access in a good vein in DN 3 …”

Section: Introductionmentioning

confidence: 99%

“…It is challenging to create vascular access in a good vein in DN. 3 The traditional percutaneous transluminal angioplasty (PTA) method of AVF is the expansion of the RA using an aortic balloon under ultrasound guidance or digital subtraction angiography. However, the high risk of tearing the RA by PTA in the clinical setting limits the possibility of achieving a satisfactory lumen of the RA.…”

Section: Introductionmentioning

confidence: 99%

Long‐segment restrictive tear of radial artery under ultrasound guide for arteriovenous fistula by PTA: A case report

Xie

Zhu

et al. 2022

Clinical Case Reports

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Effect of Inflow Arterial Calcification on Arteriovenous Fistula Maturation

Cited by 10 publications

References 29 publications

Mechanical and chemical cues synergistically promote human venous smooth muscle cell osteogenesis through integrin β1‐ERK1/2 signaling: A cell model of hemodialysis fistula calcification

Mechanical and chemical cues synergistically promote human venous smooth muscle cell osteogenesis through integrin β1‐ERK1/2 signaling: A cell model of hemodialysis fistula calcification

Does Anticoagulation Improve Flap Outcomes in Hypercoagulable Patients? A Systematic Review

Long‐segment restrictive tear of radial artery under ultrasound guide for arteriovenous fistula by PTA: A case report

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