Fibrotic Venous Remodeling and Nonmaturation of Arteriovenous Fistulas

Journal of the American Society of Nephrology : JASN
Laisel MartinezRoberto I Vazquez-Padron

Abstract

The frequency of primary failure in arteriovenous fistulas (AVFs) remains unacceptably high. This lack of improvement is due in part to a poor understanding of the pathobiology underlying AVF nonmaturation. This observational study quantified the progression of three vascular features, medial fibrosis, intimal hyperplasia (IH), and collagen fiber organization, during early AVF remodeling and evaluated the associations thereof with AVF nonmaturation. We obtained venous samples from patients undergoing two-stage upper-arm AVF surgeries at a single center, including intraoperative veins at the first-stage access creation surgery and AVFs at the second-stage transposition procedure. Paired venous samples from both stages were used to evaluate change in these vascular features after anastomosis. Anatomic nonmaturation (AVF diameter never ≥6 mm) occurred in 39 of 161 (24%) patients. Neither preexisting fibrosis nor IH predicted AVF outcomes. Postoperative medial fibrosis associated with nonmaturation (odds ratio [OR], 1.55; 95% confidence interval [95% CI], 1.05 to 2.30; P=0.03, per 10% absolute increase in fibrosis), whereas postoperative IH only associated with failure in those individuals with medial fibrosis over the population's...Continue Reading

References

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Dec 24, 2015·Radiology·Michelle L RobbinUNKNOWN Hemodialysis Fistula Maturation Study Group
Mar 26, 2016·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Marwan TabbaraRoberto I Vazquez-Padron
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Citations

Oct 15, 2019·The Journal of Vascular Access·Juan C DuqueRoberto I Vazquez-Padron
Mar 9, 2021·Frontiers in Bioengineering and Biotechnology·Yan-Ting ShiuKatalin Kauser
Apr 6, 2021·The Journal of Vascular Access·John J ManovRoberto Vazquez-Padron
May 8, 2021·The Journal of Vascular Access·Roberto I Vazquez-PadronMarwan Tabbara

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