Preexisting Venous Calcification Prior to Dialysis Vascular Access Surgery

Abstract

Vascular calcification is present in arterial vessels used for dialysis vascular access creation prior to surgical creation. Calcification in the veins used to create a new vascular access has not previously been documented. The objective of this study was to describe the prevalence of venous calcification in samples collected at the time of vascular access creation. 67 vein samples were studied. A von Kossa stain was performed to quantify calcification. A semi-quantitative scoring system from 0–4+ was used to quantify the percentage positive area for calcification as a fraction of total area (0=0; 1+ = 1–10%; 2+ =11–25%; 3+ = 26–50%; 4+ >50% positive). 22/67(33%) samples showed evidence of venous calcification. Histologic examination showed varying degrees of calcification within each cell layer. Among the subset of patients with calcification, 4/22 (18%), 19/22 (86%), 22/22 (100%), and 7/22 (32%) had calcification present within the endothelium, intima, media, and adventitia, respectively. The mean semi-quantitative scores of the 22 samples with calcification were 0.18±0.08, 1.2±0.14, 1.6±0.13, and 0.36±0.12 for the endothelium, intima, media, and adventitia, respectively. Our results demonstrate that vascular calcification is present within veins used to create new dialysis vascular access, and located predominately within the neointimal and medial layers.

New Insights into Dialysis Vascular Access: Impact of Preexisting Arterial and Venous Pathology on AVF and AVG Outcomes

“…In contrast, medial calcification is highly prevalent in the peripheral (brachial and radial) arteries, particularly in patients with advanced CKD (41). Interestingly, preexisting calcification has been detected in all vascular layers of veins used for hemodialysis access creation from the endothelium to the adventitia (42).…”

Vascular Access Calcification and Arteriovenous Fistula Maturation

“…Venous calcification and vascular access outcomes were not reported in this study. Lee et al, using Von Kossa staining evaluated 67 veins collected at the time of new vascular access creation [46]. Twenty-two of 67 (33%) samples showed the presence of venous calcification [46].…”

“…Lee et al, using Von Kossa staining evaluated 67 veins collected at the time of new vascular access creation [46]. Twenty-two of 67 (33%) samples showed the presence of venous calcification [46]. Among the subset of patients with documented venous calcification, 4/22 (18%), 19/22 (86%), 22/22 (100%), and 7/22(32%) had calcification present within the endothelium, intima, media, and adventitia, respectively [46].…”

Candidate Gene Analysis of Arteriovenous Fistula Failure in Hemodialysis Patients

“…Morphologically, these stenotic lesions closely resemble restenotic lesions after percutaneous coronary intervention (12,13). Additional specific pathophysiologic stimuli for intimal hyperplasia in vascular access stenosis include the abnormal calcium/phosphate metabolism in patients with CKD that result in arterial as well as venous calcification of the tunica media (14). Therefore, processes related to vascular function and remodeling, growth factors for extracellular matrix formation, inflammation, coagulation, and calcium/phosphate metabolism probably play an important role in AVF failure.…”