Correlation of Pre-existing Vascular Pathology With Arteriovenous Graft Outcomes in Hemodialysis Patients

Allon, Michael; Litovsky, Silvio; Young, Carlton J.; Deierhoi, Mark H.; Goodman, Jeremy; Hanaway, Michael J.; Lockhart, Mark E.; Robbin, Michelle L.

doi:10.1053/j.ajkd.2013.03.040

Cited by 29 publications

(34 citation statements)

References 19 publications

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“…Similarly, greater medial fibrosis or microcalcification of arteries was associated with a lower frequency of AVG interventions. In contrast, none of the above variables (arterial IH, venous IH, severe arterial medial fibrosis, and severe arterial calcification) were able to predict primary unassisted patency or the time to first access intervention (55). The lack of association of preexisting vascular pathology with primary unassisted AVG patency might indicate that the study was underpowered.…”

Section: Preexisting Vascular Pathology and Avg Outcomesmentioning

confidence: 87%

“…Published investigations have shown no association between individual arterial or venous histopathologic findings and access outcomes in relatively small cohorts. The only two studies that simultaneously assessed multiple preexisting conditions on preaccess arteries failed to report any potential interaction between two or more of these vascular pathologies and vascular access outcomes (38,55). However, studies that integrate the potential effect of multiple venous pathologies are lacking.…”

Section: Discussionmentioning

confidence: 99%

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

Vázquez-Padrón

Allon

2016

CJASN

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Despite significant improvements in preoperative patient evaluation and surgical planning, vascular access failure in patients on hemodialysis remains a frequent and often unforeseeable complication. Our inability to prevent this complication is, in part, because of an incomplete understanding of how preexisting venous and arterial conditions influence the function of newly created arteriovenous fistulas and grafts. This article reviews the relationship between three preexisting vascular pathologies associated with CKD (intimal hyperplasia, vascular calcification, and medial fibrosis) and hemodialysis access outcomes. The published literature indicates that the pathogenesis of vascular access failure is multifactorial and not determined by any of these pathologies individually. Keeping this observation in mind should help focus our research on the true causes responsible for vascular access failure and the much needed therapies to prevent it.

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Section: Preexisting Vascular Pathology and Avg Outcomesmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

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

Vázquez-Padrón

Allon

2016

CJASN

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“…Of note, these therapies will be limited to prevent postsurgical NIH and not preexisting neointimal lesions in the vein. The existence of preexisting NIH in veins of hemodialysis patients has been recently described, and its presence is not associated with A-V fistula outcomes (1,3,24). …”

Section: Discussionmentioning

confidence: 98%

c-Kit signaling determines neointimal hyperplasia in arteriovenous fistulae

Skartsis

Martinez

Duque

et al. 2014

American Journal of Physiology-Renal Physiology

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Skartsis N, Martinez L, Duque JC, Tabbara M, Velazquez OC, Asif A, Andreopoulos F, Salman LH, Vazquez-Padron RI. c-Kit signaling determines neointimal hyperplasia in arteriovenous fistulae. Am J Physiol Renal Physiol 307: F1095-F1104, 2014. First published September 3, 2014 doi:10.1152/ajprenal.00292.2014.-Stenosis of arteriovenous (A-V) fistulae secondary to neointimal hyperplasia (NIH) compromises dialysis delivery, which worsens patients' quality of life and increases medical costs associated with the maintenance of vascular accesses. In the present study, we evaluated the role of the receptor tyrosine kinase c-Kit in A-V fistula neointima formation. Initially, c-Kit was found in the neointima and adventitia of human brachiobasilic fistulae, whereas it was barely detectable in control veins harvested at the time of access creation. Using the rat A-V fistula model to study venous vascular remodeling, we analyzed the spatial and temporal pattern of c-Kit expression in the fistula wall. Interestingly, c-Kit immunoreactivity increased with time after anastomosis, which concurred with the accumulation of cells in the venous intima. In addition, c-Kit expression in A-V fistulae was positively altered by chronic kidney failure conditions. Both blockade of c-Kit with imatinib mesylate (Gleevec) and inhibition of stem cell factor production with a specific short hairpin RNA prevented NIH in the outflow vein of experimental fistulae. In agreement with these data, impaired c-Kit activity compromised the development of NIH in A-V fistulae created in c-Kit W/Wv mutant mice. These results suggest that targeting of the c-Kit signaling pathway may be an effective approach to prevent postoperative NIH in A-V fistulae. arteriovenous fistula; hemodialysis; neointima THE ARTERIOVENOUS (A-V) fistula is the preferred type of vascular access for hemodialysis patients (29). It achieves higher patency rates, has fewer complications than synthetic grafts (12,29,31), and has a lower risk of infections than central venous catheters (17,29). Despite its advantages, A-V fistulae frequently fail to mature or become dysfunctional after successful dialysis sessions, and this occurs primarily due to the development of neointimal hyperplasia (NIH) within the A-V fistula circuit (2, 5, 39). Stenosed A-V fistulae can sometimes be salvaged through angioplasty or surgical interventions, but these attempts often result in restenosis or additional complications (32). Therefore, there is an unmet medical need for treatments that prevent NIH and improve A-V fistula function. To this end, it is necessary to better define the factors underlying the pathological remodeling of the A-V fistula wall.A-V fistula maturation is a dynamic vascular process with multiple factors contributing to the development of NIH. These include vein configuration (22) In the present study, we investigated the role of c-Kit in the pathological remodeling of A-V fistulae. We show that activation of the c-Kit signaling pathway in adventitial and neointimal cells precedes arteri...

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“…A second study found no association of preexisting arterial medial fibrosis or arterial calcification with AVF nonmaturation (18). In contrast, a third study observed a lower frequency of arteriovenous graft (AVG) interventions in patients with preexisting arterial or venous pathology, suggesting a protective effect against neointimal hyperplasia in vascular access (24). These contradictory findings suggest that the cellular mechanisms leading to neointimal hyperplasia after AVF creation differ from those leading to the preexisting ;vascular abnormalities in uremic patients.…”

mentioning

confidence: 96%