The Sisyphean Task of Getting the Arteriovenous Fistula to Mature

Bartolomeo, Korey; Vachharajani, Tushar J.; Shingarev, Roman

doi:10.34067/kid.0007452021

Cited by 1 publication

(1 citation statement)

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“…Following surgical creation, the AVF undergoes the process of maturation. Currently, however, no established consensus exists on the definition of a mature AVF [ 13 ]. The National Kidney Foundation-Kidney Dialysis Outcomes Quality Initiative defines a mature AVF as being at least 6 mm in diameter, less than 6 mm deep, and with a blood flow of at least 600 mL/min [ 14 ].…”

Section: Pathophysiology Of Venous Neointimal Hyperplasiamentioning

confidence: 99%

Localized Perivascular Therapeutic Approaches to Inhibit Venous Neointimal Hyperplasia in Arteriovenous Fistula Access for Hemodialysis Use

et al. 2022

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An arteriovenous fistula (AVF) is the preferred vascular access for chronic hemodialysis, but high failure rates restrict its use. Optimizing patients’ perioperative status and the surgical technique, among other methods for preventing primary AVF failure, continue to fall short in lowering failure rates in clinical practice. One of the predominant causes of AVF failure is neointimal hyperplasia (NIH), a process that results from the synergistic effects of inflammation, hypoxia, and hemodynamic shear stress on vascular tissue. Although several systemic therapies have aimed at suppressing NIH, none has shown a clear benefit towards this goal. Localized therapeutic approaches may improve rates of AVF maturation by providing direct structural and functional support to the maturating fistula, as well as by delivering higher doses of pharmacologic agents while avoiding the adverse effects associated with systemic administration of therapeutic agents. Novel materials—such as polymeric scaffolds and nanoparticles—have enabled the development of different perivascular therapies, such as supportive mechanical devices, targeted drug delivery, and cell-based therapeutics. In this review, we summarize various perivascular therapeutic approaches, available data on their effectiveness, and the outlook for localized therapies targeting NIH in the setting of AVF for hemodialysis use. Highlights: Most systemic therapies do not improve AVF patency outcomes; therefore, localized therapeutic approaches may be beneficial. Locally delivered drugs and medical devices may improve AVF patency outcomes by providing biological and mechanical support. Cell-based therapies have shown promise in suppressing NIH by delivering a more extensive array of bioactive substances in response to the biochemical changes in the AVF microenvironment.

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Section: Pathophysiology Of Venous Neointimal Hyperplasiamentioning

confidence: 99%