Smooth Muscle Changes in the Cephalic Vein of Renal Failure Patients before Use as an Arteriovenous Fistula(AVF).

Abstract

Complications in arteriovenous fistula (AVF) occur in up to 35% of renal failure patients on hemodialysis. The most frequent complication is thrombosis, usually from stenotic lesions in the venous outflow system. To study the pre-existing smooth muscle changes in the cephalic vein of these patients, we prospectively collected a total of 17 cephalic vein specimens from 3 normal controls and 14 renal failure patients undergoing primary AVF construction on the chosen limb. After preparation, ultrathin sections were stained with uranyl and lead acetate and were examined under the transmission electron microscope (TEM). Compared with the normal controls, abnormal fibrous infiltration of the intima and the media and varying degrees of smooth muscle degenerative changes were observed in all the cephalic vein sections of renal failure patients. Smooth muscle cells (SMCs) lost their normal fusiform shape and were widely separated by increased amount of irregularly disposed, extracellular collagen fibers. Other cellular abnormalities included irregular cell membrane, granular cytoplasm, Peri- and Paranuclear vacuoles and mega mitochondria. SMCs also showed morphological expression of phagocytosis of collagen and elastic fibers as a sign of remodeling of the vein wall. In conclusion, pre-existing wall and smooth muscle changes were observed in all the cephalic vein sections of renal failure patients, which may contribute to the later complications of AVFs.

Vein wall dissection: A rare puncture-related complication of brachiocephalic fistula. Gray-scale and color Doppler sonographic findings

“…It is possible that the vein wall lesion occurred at the time of cannulation when the needle bevel was rotated. Intima and media fibrosis as well as other pre-existing vein wall abnormalities similar to those found by Wali et al 4 in cephalic vein segments of renal failure patients may have played a role in the development of VWD.…”

From Structure to Function: Mitochondrial Morphology, Motion and Shaping in Vascular Smooth Muscle

“…For example, in the vascular system in pulmonary hypertension [33], mitochondria were smaller than those in control pulmonary artery smooth muscle. In venous smooth muscle from patients with renal failure [34], mitochondria were larger than controls. These observations suggest the organelle's structure undergoes change in vascular disease.…”

Novel Paradigms for Dialysis Vascular Access

“…In patients undergoing AVF creation, preexisting radial artery neointimal hyperplasia (16) and increased intima-media thickness in the radial artery correlated with early failure of radiocephalic AVFs (17). In these patients, there is preexisting neointimal hyperplasia on the cephalic vein (12,18) and major changes in the vascular SMC component (19) are present even before AVF construction, making arterial vessel less compliant. Thus, previous conditions of arm blood vessels strongly influence the outcome of vascular access, in early as well as in late AVF failure.…”