Morphometric and histological parameters in veins of diabetic patients undergoing brachiocephalic fistula placement

Abstract

Diabetic patients with end-stage renal failure have higher rates of arteriovenous failures when compared with nondiabetics. The aim was to compare differences in indicators of vascular remodeling and endothelial dysfunction in veins of patients with or without diabetes at the time of surgical placement. In this prospective observational trial, vein samples were collected from patients when a brachiocephalic fistula was created. Morphometric measurements and extent of fibrosis were determined using Image J software. Histological analysis, for the presence of myofibroblasts and level of endothelial nitric oxide synthase, was performed by immunohistochemical staining and scored in semi-quantitative manner. Asymmetric dimethylarginine was determined at the time of access placement. Comparison of diabetics and nondiabetics was performed using Wilcoxon rank sum and Fisher’s exact tests. Eighteen patients were included; 10 were diabetics. There was a significant difference in the measurement of vein area between groups, with diabetic vein samples having larger luminal area of average 832,001.18 µm2 (317,582.17–3,695,670.36, P = 0.04). The maximal intimal to medial thickness ratio was higher in diabetic vein samples (0.71 vs. 0.24, P = 0.03) along with statistically significant higher maximal intimal thickness (312.12 vs. 115.14 µm, P = 0.03). There is a significant difference in vascular wall remodeling between diabetics and nondiabetics at the level of the cephalic vein at the time of brachiocephalic placement. The unexpected finding of significantly larger luminal area in diabetic veins could be a major factor positively affecting brachiocephalic outcomes in otherwise impaired remodeling in this patient population.

Hemodynamic and Biologic Determinates of Arteriovenous Fistula Outcomes in Renal Failure Patients

“…The morphometric and histologic characteristics of the veins used for fistula creation have been studied. Lazich et al have shown that the vein used to create BCF is larger in diabetics when compared to nondiabetics [ 24 ]. In particular the internal lumen and intimal and medial area were all found to be more dilated in diabetics [ 24 ].…”

“…Lazich et al have shown that the vein used to create BCF is larger in diabetics when compared to nondiabetics [ 24 ]. In particular the internal lumen and intimal and medial area were all found to be more dilated in diabetics [ 24 ]. This altered remodeling may be beneficial as previous reports have shown that cephalic arch venous stenosis is attenuated in diabetics with BCF [ 25 – 27 ].…”

“…This altered remodeling may be beneficial as previous reports have shown that cephalic arch venous stenosis is attenuated in diabetics with BCF [ 25 – 27 ]. Vascular wall remodeling differs between diabetics and nondiabetics with increased NH in the former [ 23 , 24 ]. As NH progresses, this can dramatically decrease the lumen size and lead to negative vascular remodeling and vasoconstriction.…”

Histopathology of Veins Obtained at Hemodialysis Arteriovenous Fistula Creation Surgery

“…However, available studies examining this question have shortcomings, including lack of morphometric histologic analysis, confinement to single institutions, and small sample sizes, that may contribute to the wide range reported for prevalence of preexisting venous neointima. [3][4][5][6][7][8][9] Furthermore, little is known about alterations in other structural compartments of the vein or their potential pathophysiologic significance.…”

Role of a RhoA/ROCK-Dependent Pathway on Renal Connexin43 Regulation in the Angiotensin II-Induced Renal Damage

“…Tissue damage was evaluated by a semi-quantitative morphometric analysis that was performed according to the immunoreactivity intensity observed in the kidney tissue sample for each of the antibodies used (OPN, ED-1, α-SMA, Col III). This was done from a score on a scale from negative to positive three (− to +++), defined according to the immunoreactivity intensity observed in the kidney tissue sample ([−] = 0-10%, [+] = 10-40%, [++] = 40-70% y [+++] = 70-100% of the area observed) [62][63][64][65]. To assess the degree of fibrosis, staining of collagen fibrils by Sirius red F3BA was carried out as previously described [66].…”