Venous neointimal hyperplasia in polytetrafluoroethylene dialysis grafts

Roy‐Chaudhury, Prabir; Kelly, Burnett S.; Miller, Mary Ann; Reaves, Anita; Armstrong, Janice; Nanayakkara, Nuwan D.; Heffelfinger, Sue C.

doi:10.1046/j.1523-1755.2001.0590062325.x

Cited by 29 publications

(34 citation statements)

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“…It is mainly due to venous neointimal hyperplasia (VNH) followed by vascular stenosis and subsequent thrombosis [1,2,3]. In VNH, injured endothelial cells accelerate the expression of adhesion molecules and tissue factors, elevate inflammatory cytokines [4], increase activated platelet aggregation, and finally lead to regional stenosis and thrombosis [5].…”

Section: Introductionmentioning

confidence: 99%

Clopidogrel Effectively Suppresses Endothelial Microparticle Generation Induced by Indoxyl Sulfate via Inhibition of the p38 Mitogen-Activated Protein Kinase Pathway

Ryu

Kim²

2011

Blood Purif

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Background/Aims: Endothelial microparticles (EMPs) are closely associated with vascular dysfunction. We investigated the effects of several drugs on EMP generation in human umbilical vein endothelial cells (HUVECs), and the involvement of the mitogen-activated protein kinase (MAPK) in EMP generation. Methods: CD31+CD42-EMP counts were measured by flow cytometry in supernatants of HUVECs incubated with indoxyl sulfate. The EMP responses to losartan, lovastatin, clopidogrel, and mesoglycan were examined. We then measured the effects of MAPK inhibitors on EMPs. Results: (1) Indoxyl sulfate induced EMP release in HUVECs in a dose-dependent fashion; (2) all drugs (10–50 µM) inhibited EMP generation induced by indoxyl sulfate, with clopidogrel being the most effective; (3) the p38 MAPK inhibitor suppressed EMP generation induced by indoxyl sulfate, and (4) clopidogrel significantly suppressed MAPK signaling activated by indoxyl sulfate, with the most potency on p38. Conclusion: The p38 signaling involves EMP generation induced by indoxyl sulfate and is effectively suppressed by clopidogrel.

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Section: Introductionmentioning

confidence: 99%

Clopidogrel Effectively Suppresses Endothelial Microparticle Generation Induced by Indoxyl Sulfate via Inhibition of the p38 Mitogen-Activated Protein Kinase Pathway

Ryu

Kim²

2011

Blood Purif

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“…The main reason for this decrease in access blood flow is intimal hyperplasia formation at the venous anastomosis or in the outflow tract of the graft [16,17]. The underlying mechanism seems to be the marked increase in shear stress in the thin-walled outflow vein, which triggers focal fibromuscular hyperplasia and causes a fibrotic venous lesion to appear [18,19,20]. Some other non‐stenotic causes that have been proposed to lead to low access flow and access thrombosis are the following: hypotension, hypovolemia and external compression [21].…”

Section: Discussionmentioning

confidence: 99%

Activated Protein C-Resistance Determination and Vascular Access Thrombosis in Populations with High Prevalence of Factor V Leiden

Androulakis

Tzenakis²,

Nioti³

et al. 2015

Nephron

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Background/Aims: Factor V Leiden heterozygosity occurs in 3-8% of the general European and US populations. Activated protein C resistance (APC-R) - a non-molecular laboratory test - can efficiently demonstrate the presence of this mutation and can be performed on most coagulation analyzers. On the other hand, fistula or graft thrombosis is a common and costly complication in hemodialysis patients. Our aim was to establish the value of APC-R determination in hemodialysis patients by assessing the risk of access thrombosis in patients with increased APC-R. Methods: A total of 133 patients (81 men, mean age 64.5 ± 14.9 years and 52 women, mean age 63.6 ± 15 years) were selected. Participants were divided into 2 groups: those with access thrombosis (54 patients, 40.6%) and those with no access thrombosis (79 patients, 59.4%), and they were tested for the most common congenital or acquired thrombophilia risk factors. Results: Overall, 12 patients (9%) had an increased APC-R and 10 of them had at least 1 episode of access thrombosis (83.3%). Univariate analysis to estimate crude odds ratio (OR) showed an OR of 8.8 (95% CI 1.8-41.8) times higher risk for access thrombosis in these patients. No significant differences were found after adjusting for age, hypertension, diabetes mellitus, coronary artery disease, cerebrovascular disease, peripheral arterial disease and malignancy. Sex was also a factor influencing thrombosis, presenting a higher OR for women (OR 2.2, 95% CI 1.1-4.4). Conclusion: This study revealed a significant association between access thrombosis and increased APC-R in hemodialysis patients. This indicates that the determination of APC-R should be considered - especially, in populations with a high prevalence of Factor V Leiden - as proper anticoagulant therapy in these patients may reduce the risk of access thrombosis.

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“…Obwohl ePTFE-Grafts für viele Dialysepatienten eine akzeptable Option als Shuntmaterial darstellen, sind sie dafür bekannt, eine neointimale Hyperplasie im Bereich der venösen Anastomose auszulösen [25]. Die neointimale Hyperplasie ist eine "normale" Reaktion des Körpers auf einen abnormen Blutfluss.…”

Section: » Prothesenshunts Sind Für Permanente Dialyseshunts Nur Die unclassified

Innovationen von Dialyseshuntprothesen

et al. 2012

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Den aktuellen Leitlinien [22, 29] ent sprechend stellen autologe arterio venöse Fisteln die erste Wahl bei der Anlage eines Hämodialysezugangs dar. Dies ist nicht immer möglich und viele Patienten benötigen Prothesen grafts. In der Regel können diese eher punktiert werden als autologe Fisteln, haben allerdings langfristig eine kürzere Offenheitsrate. Dieser Artikel betrachtet Innovationen zu Design und Material von Shunt prothesen die helfen, deren Lang lebigkeit und Nutzbarkeit zu verbes sern und bekannte Komplikationen zu reduzieren. Prothesen in der ShuntchirurgieEs ist bekannt, dass autologe arteriovenöse Fisteln mit einer primären Offenheit von 65-90% und 60%-80% nach einem bzw. zwei Jahren eine bessere Langzeitoffenheitsrate aufweisen als andere Shuntanlagen. Die Inzidenz von Thrombosen (0,2 Ereignisse/Patient/Jahr) und Infektionen (2%) ist niedrig [9,24,29].Prothesenshunts sind nur die zweitbeste Wahl für einen permanenten Dialyseshunt. Sie bieten nach einem bzw. zwei Jahren deutlich niedrigere primäre (60-80% bzw. 30-40%) und sekundäre (70-90% bzw. 50-70%) Offenheitsraten. Sie spielen aber für die wachsende Patientenpopulation mit terminalem Nierenversagen, die einen dauerhaften Hämodialyse-zugang benötigen, eine wichtige Rolle. Einerseits wird dies durch das steigende Alter verursacht, in dem Patienten eine Hä-modialyse beginnen, andererseits durch den ständigen Drang, den Gebrauch von zentralvenösen Dialysekathetern in dieser Patientengruppe zu reduzieren [22,29].Kunststoffmaterial spielt seit der Einführung des Scribner-Shunts [4, 10] eine wichtige Rolle in der Shuntchirurgie. Die Nutzung synthetischer Gefäßprothesen aus Polyethylenterephthalat (Dacron) [8] und expandiertem Polytetrafluorethylen (ePTFE) [31] seit den frühen 1970er Jahren hat sowohl die Gefäßchirurgie im Allgemeinen als auch speziell die Shuntchirurgie revolutioniert. Mit der Möglichkeit ein Material mit weitgehend thromboseabweisender Oberfläche, adäquater mechanischer Festigkeit, hoher Biokompatibilität und rascher Gewebeinkorporation in verschiedenen Größen und Konfigurationen nutzen zu können, eröffneten sich neue Horizonte für die Gefäßchirurgie und die Herstellung von Dialyseshunts, die so zuvor nicht vorstellbar waren.

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Venous neointimal hyperplasia in polytetrafluoroethylene dialysis grafts

Cited by 29 publications

References 0 publications

Clopidogrel Effectively Suppresses Endothelial Microparticle Generation Induced by Indoxyl Sulfate via Inhibition of the p38 Mitogen-Activated Protein Kinase Pathway

Clopidogrel Effectively Suppresses Endothelial Microparticle Generation Induced by Indoxyl Sulfate via Inhibition of the p38 Mitogen-Activated Protein Kinase Pathway

Activated Protein C-Resistance Determination and Vascular Access Thrombosis in Populations with High Prevalence of Factor V Leiden

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