Abstract:
:For patients with end-stage renal disease requiring hemodialysis, their vascular access is both their lifeline and their Achilles heel. Despite being recommended as primary vascular access, the arteriovenous fistula (AVF) shows sub-optimal results, with about 50% of patients needing a revision during the year following creation. After the AVF is created, the venous wall must adapt to new environment. While hemodynamic changes are responsible for the adaptation of the extracellular matrix and activation of the endothelium, surgical dissection and mobilization of the vein disrupt the vasa vasorum, causing wall ischemia and oxidative stress. As a consequence, migration and proliferation of vascular cells participate in venous wall thickening by a mechanism of neointimal hyperplasia (NH). When aggressive, NH causes stenosis and AVF dysfunction. In this review we show how hypoxia, metabolism, and flow parameters are intricate mechanisms responsible for the development of NH and stenosis during AVF maturation.
journal_name
Int J Mol Scijournal_title
International journal of molecular sciencesauthors
Sadaghianloo N,Contenti J,Dardik A,Mazure NMdoi
10.3390/ijms20215387subject
Has Abstractpub_date
2019-10-29 00:00:00issue
21issn
1422-0067pii
ijms20215387journal_volume
20pub_type
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