Functional and structural response of arterialized femoral veins in a rodent AV fistula model

Langer, Stephan; Heiß, Christian; Paulus, Niklas; Bektas, Nuran; Mommertz, G.; Rowinska, Zuzanna; Westenfeld, Ralf; Jacobs, Michael J.; Fries, Michael; Koeppel, Thomas A.

doi:10.1093/ndt/gfp033

Cited by 34 publications

(46 citation statements)

References 22 publications

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“…51 Finally, as shown in recent studies, in hemodialysis patients undergoing angioplasty of stenotic AVFs, higher plasma levels of ADMA are strongly predictive of the risk for restenosis. 52 The femoral AVF model in the rat, as described in the present and recent studies, 11,14,53 complements other rodent models used to study AVF failure. For example, the murine AVF model recapitulates the salient features of dysfunctional and failing human AVFs, 10 and when created in genetically altered mice, allows the interrogation of the functional significance of specific genes; this murine model was recently used in the examination of the pathobiologic significance of heme oxygenase-1 12 and osteopontin in an AVF, 13 and the therapeutic efficacy of bone morphogenetic protein 7 in this murine model when created in mice with chronic kidney disease.…”

Section: Discussionmentioning

confidence: 81%

“…11,14 These histological findings and the accompanying marked induction of genes incriminated in vascular access dysfunction (for example, MCP-1, IL-6, transforming growth factor-␤1, plasminogen activator inhibitor-1, and matrix metalloproteinase-9), in aggregate, thus demonstrate that this model is a faithful one by which to study the pathophysiologic mechanisms underlying dysfunction of hemodialysis AVFs, and to examine strategies that may extend the longevity of these AVFs. .…”

Section: Discussionmentioning

confidence: 86%

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Characterization of a Model of an Arteriovenous Fistula in the Rat

Croatt

Grande

Hernandez

et al. 2010

The American Journal of Pathology

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Vascular access dysfunction contributes to the mortality of patients undergoing chronic hemodialysis. The present study analyzed the changes that evolve in a femoral arteriovenous fistula in the rat. The venous segment of this model exhibited, at 1 week, activation of pro-inflammatory transcription factors and up-regulation of pro-inflammatory , proliferative , procoagulant, and profibrotic genes; and at 4 weeks, the venous segment displayed neointimal hyperplasia, smooth muscle proliferation, and thrombus formation. These changes were accompanied by endothelial (e) nitric oxide synthase (NOS) and inducible (i) NOS up-regulation. The administration of N G -nitro-L-arginine methyl ester, an inhibitor of NOS activity, increased venous neointimal hyperplasia and pro-inflammatory gene expression (monocyte chemoattractant protein؊1 and cytokine-induced neutrophil chemoattractant-1), increased systolic blood pressure, and decreased blood flow through the fistula. In another hypertensive model, the rat subtotal nephrectomy model, venous neointimal hyperplasia in the arteriovenous fistula was also exacerbated. We conclude that this arteriovenous fistula model recapitulates the salient features observed in dysfunctional, hemodialysis arteriovenous fistulas, and that venous neointimal hyperplasia is exacerbated when this model is superimposed in two different models of systemic hypertension. Since the uremic milieu contains increased amounts of asymmetric dimethylarginine , we speculate that such accumulation of this endogenous inhibitor of NOS , by virtue of its pressor or nitric oxide-depleting effects , or a combination thereof , may contribute to the limited longevity of arteriovenous fistulas used for hemodialysis.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 86%

Characterization of a Model of an Arteriovenous Fistula in the Rat

Croatt

Grande

Hernandez

et al. 2010

The American Journal of Pathology

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“…Only one death occurred during the procedure, due to uncontrolled bleeding of the artery, and after this case two temporary clips were used together to control the artery. Mortality rates in fistula studies have generally ranged between 0 and 47% [16, 22-24]. Most of the deaths occur 24–48 h after surgery, because of congestive heart failure (CHF) or for unknown reasons [16, 22, 25].…”

Section: Discussionmentioning

confidence: 99%

“…No postoperative deaths and no infections were observed in the current study. Langer et al [24] reported one case of thrombosis after infection in femoral vessel fistulae. The CJF model has some limitations because it is not as simple as the ACF model, using needle piercing and requiring a well-set-up microsurgery research laboratory.…”

Section: Discussionmentioning

confidence: 99%

Carotid-Jugular Fistula Model to Study Systemic Effects and Fistula-Related Microcirculatory Changes

et al. 2018

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Background: Arteriovenous fistulae impair the distal circulation, but their effects at the microcirculatory level are not well understood. This study presents the carotid-jugular fistula (CJF) as a model to evaluate fistula-related microcirculatory and systemic changes. Materials and Methods: Female Wistar rats were anesthetized and divided into a fistula group (FG, n = 10) and a sham group (SG, n = 6). End-to-end anastomosis was performed between the right carotid artery and the jugular vein in the FG. The hemodynamic status was followed for 6 weeks. On the sixth postoperative week, liver and kidney microcirculation was measured using laser Doppler; then microcirculatory changes were assessed after occlusion of the carotid artery. At the end of the experiment, histological samples were taken and the weights of the organs were measured. Results: The heart rate and systolic blood pressure decreased significantly due to the CJF. Laser Doppler showed a reduction in liver blood flow units (BFU) in the FG in comparison with the SG (p = 0.01), and they increased (p < 0.01) after occlusion of the fistula. Kidney BFU showed slight changes only. The comparative morphological study revealed significant increases in heart weight (p < 0.001) and left ventricular hypertrophy (p = 0.008) in the FG. Conclusion: Beside hemodynamic and morphologic changes, a CJF causes a deterioration in the microcirculation of the liver rather than of the kidney, but occlusion of the CJF immediately reverses these changes.

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“…The additional advantage of the forearm graft is that it sets the stage for creation of a secondary fistula (25)(26)(27)(28). The upper arm basilic and cephalic veins serve as the effluent conduits for the forearm graft and are subjected to the same mechanical and neuro-humoral signals that are involved in fistula maturation (29). Finally, because these veins have already dilated and their walls are thickened, they can be cannulated for dialysis use after conversion to a secondary fistula with no or minimal delay (27).…”

Section: Suboptimal or Inadequate Forearm Vessels Or Failed Accessmentioning

confidence: 99%

Interventional Nephrology

Urbanes¹

2013

Clinical Journal of the American Society of Nephrology

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SummaryThe patient's vascular access is critical in ensuring that hemodialysis is successful, effective, relatively uncomplicated, and consistently reproducible from one treatment to another. The choice of vascular access is dictated by a multitude of factors, some of which are generalizable to a larger system, and others of which are flavored by local experience and expertise; an important fraction is specific to the patient presenting to the clinician at a particular point in time. Some of these factors, such as patient age and sex, are not modifiable; others, like comorbidity, vessel size and urgency of presentation to the renal provider, are manageable and sometimes modifiable. The role of the autologous arteriovenous fistula as the ideal conduit for hemodialysis treatments is well established. The role of the prosthetic graft warrants discussion and investigation to most optimally apply to patients this important alternative within the armamentarium of vascular access.

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Functional and structural response of arterialized femoral veins in a rodent AV fistula model

Abstract: Our AVF model in the rat demonstrates maturation effects in fistula veins similar to typical clinical findings in haemodialysis patients. Noninvasive ultrasound proved to be a valuable tool for longitudinal in vivo monitoring of the fistulas in this rodent model.

Cited by 34 publications

References 22 publications

Characterization of a Model of an Arteriovenous Fistula in the Rat

Characterization of a Model of an Arteriovenous Fistula in the Rat

Carotid-Jugular Fistula Model to Study Systemic Effects and Fistula-Related Microcirculatory Changes

Interventional Nephrology

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