The Impact of Intima-media Thickness of Radial Artery on Early Failure of Radiocephalic Arteriovenous Fistula in Hemodialysis Patients

Kim, Young Ok; Choi, Yeong-Jin; Kim, Ji Il; Kim, Young Soo; Kim, Byung Soo; Park, Chul Whee; Song, Ho Cheol; Yoon, Sun Ae; Chang, Yoon Sik; Bang, Byung Kee

doi:10.3346/jkms.2006.21.2.284

Cited by 49 publications

(47 citation statements)

References 18 publications

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“…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.…”

Section: Mechanisms Of Intimal Hyperplasiamentioning

confidence: 99%

Novel Paradigms for Dialysis Vascular Access

Remuzzi

Ene-Iordache

2013

Clinical Journal of the American Society of Nephrology

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SummaryFailure of hemodialysis access is caused mostly by venous intimal hyperplasia, a fibro-muscular thickening of the vessel wall. The pathogenesis of venous neointimal hyperplasia in primary arteriovenous fistulae consists of processes that have been identified as upstream and downstream events. Upstream events are the initial events producing injury of the endothelial layer (surgical trauma, hemodynamic shear stress, vessel wall injury due to needle punctures, etc.). Downstream events are the responses of the vascular wall at the endothelial injury that consist of a cascade of processes including leukocyte adhesion, migration of smooth muscle cells from the media to the intimal layer, and proliferation. In arteriovenous fistulae, the stenoses occur in specific sites, consistently related to the local hemodynamics determined by the vessel geometry and blood flow pattern. Recent findings that the localization of these sites matches areas of disturbed flow may add new insights into the pathogenesis of neointimal hyperplasia in the venous side of vascular access after the creation of the anastomosis. The detailed study of fluid flow motion acting on the vascular wall in anastomosed vessels and in the arm vasculature at the patient-specific level may help to elucidate the role of hemodynamics in vascular remodeling and neointimal hyperplasia formation. These computational approaches may also help in surgical planning for the amelioration of clinical outcome. This review aims to discuss the role of the disturbed flow condition in acting as upstream event in the pathogenesis of venous intimal hyperplasia and in producing subsequent local vascular remodeling in autogenous arteriovenous fistulae used for hemodialysis access. The potential use of blood flow analysis in the management of vascular access is also discussed.

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Section: Mechanisms Of Intimal Hyperplasiamentioning

confidence: 99%

Novel Paradigms for Dialysis Vascular Access

Remuzzi

Ene-Iordache

2013

Clinical Journal of the American Society of Nephrology

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“…Vascular stenosis of arteriovenous fistula is primarily the result of neointimal hyperplasia [49,50]. The pathophysiology of neointimal hyperplasia consists of the presence of extracellular matrix deposition and proliferation, adherence, and migration of vascular smooth muscle cell (VSMC), which represents abnormal healing.…”

Section: Endothelium Dysfunction and Avf Maturationmentioning

confidence: 99%

An overview of AVF maturation and endothelial dysfunction in an advanced renal failure

et al. 2017

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Life expectancy in patient with established kidney failure is considerably shortened with worsening quality of life. Through the provision of renal replacement therapy, survival and quality of life of advanced renal disease patients can be markedly improved. Haemodialysis and peritoneal dialysis are the treatment modalities in patients with end-stage renal disease. The efficiency of haemodialysis treatment relies on the functional status of vascular access. Vascular access and its related problems represent the main factors that determine a rise in the rate of incidence of the disease among haemodialysis patients and, consequently, a rise in the healthcare expenses. Arteriovenous fistula is the most efficient method, as it has a low risk of infection and mortality, and can ensure long-term functional access. However, maturation of an arteriovenous fistula is a complex process and is not well understood; significant numbers of arteriovenous fistula fail to develop sufficiently prior to their use for haemodialysis due to either lack of vessel maturation or spontaneous thrombosis. There are multiple blood markers and human factors that contribute to the maturation of fistula. Endothelial function is one of the most important determinants of arteriovenous fistula maturation. Early fistula failure is usually due to thrombosis which can be triggered by haematoma, by low flow rates resulting from low blood pressure, or by a hypercoagulable state. Impairment of endothelial function is associated with decreased arterial remodelling and final venous lumen diameter. Arteriovenous fistula anastomoses need early proliferation of endothelial cells to restore the barrier, permeability, and biochemical monitoring roles of endothelial cells in managing vascular repair, local thrombosis, neointimal hyperplasia, and inflammation. The purpose of this review was to discuss the maturation of AVF and endothelial dysfunction.

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“…Other studies, however, supported worse AV fistula patency rates in patients [65 years compared with younger individuals [55][56][57]. Increased age has been associated with increased intima-media thickness [58] and lower AV fistula rates [59], both associated with AV fistula failure. Therefore, based on the results of these reports, no definite conclusion could be drawn regarding the effect of age on AV fistula patency rates.…”

Section: Av Fistulae In the Elderlymentioning

confidence: 96%

Vascular access in elderly patients with end-stage renal disease

et al. 2008

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During the last few years, the number of elderly patients with end-stage renal disease (ESRD) has been increasing worldwide. Establishment of a viable vascular access is of primary importance in these patients. This review discusses the advantages and disadvantages of the available vascular access modalities [namely arteriovenous (AV) fistulae, AV grafts, and central venous catheters (CVCs)] in elderly ESRD patients. AV fistulae seem to be superior when compared with other vascular access alternatives with respect to patency, morbidity and mortality rates. On the other hand, due to the age-related advanced atherosclerosis in the elderly, higher failure rates for AV fistulae in this age group have been described. Two controversial issues, namely the higher infection and thrombosis rates in elderly ESRD patients, are also discussed. Current evidence suggests that old age should not comprise a drawback when selecting the appropriate vascular access modality (AV fistula, AV graft or CVC) for the performance of hemodialysis. The possible vascular access options in elderly ESRD patients should not be different from younger individuals.

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The Impact of Intima-media Thickness of Radial Artery on Early Failure of Radiocephalic Arteriovenous Fistula in Hemodialysis Patients

Cited by 49 publications

References 18 publications

Novel Paradigms for Dialysis Vascular Access

Novel Paradigms for Dialysis Vascular Access

An overview of AVF maturation and endothelial dysfunction in an advanced renal failure

Vascular access in elderly patients with end-stage renal disease

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