Document Detail


Endothelial function predicts positive arterial-venous fistula remodeling in subjects with stage IV and V chronic kidney disease.
MedLine Citation:
PMID:  21038305     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: The maturation of an arteriovenous fistula (AVF) requires remodeling of the arterial inflow and the venous outflow limbs to sustain flows sufficient to support hemodialysis. However, factors influencing remodeling of AVF are poorly understood. We hypothesized that AVF remodeling was an endothelium-dependent process.
METHODS: This is a prospective cohort study of patients (n=25) undergoing autologous AVF formation. Brachial artery vasoreactivity studies were performed pre-operatively to assess endothelium-dependent, flow-mediated vasodilation (FMD). High-resolution ultrasound was used to assess venous and arterial diameters intraoperatively, and at 3 months.
RESULTS: The mean age was 64.5 ± 13.6 yrs. Twelve patients (48%) had diabetes. The mean FMD for the entire cohort was (mean ± SEM) 5.82 ± 0.9%, (range) 0-17.3%. The vein increased in size 3.19 ± .28 to 6.11 ± .41 mm, 108.4 ± 17.9%, p=.0001, while the artery increased from 3.29 ± .14 to 4.48 ± .30 mm, 20.47 ± 10.8%, p=.013. There was a significant positive correlation between the degree of arterial and venous remodeling, r=.52, p=.023. Brachial artery FMD most strongly correlated with the magnitude of arterial remodeling, r=.47, p=.038. Patients with diabetes failed to undergo venous remodeling to the same extent as did those without diabetes, 59.2 ± 24.4% vs. 141.5 ± 25.4%, p=.04.
CONCLUSION: Impairment of endothelial function is associated with decreased arterial remodeling and final venous lumen diameter attained at 3 months. Further investigation is needed to determine whether modulation of endothelial function in this cohort can improve AVF maturation.
Authors:
Christopher D Owens; Nicole Wake; Ji Min Kim; Dirk Hentschel; Michael S Conte; Andres Schanzer
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  The journal of vascular access     Volume:  11     ISSN:  1724-6032     ISO Abbreviation:  J Vasc Access     Publication Date:    2010 Oct-Dec
Date Detail:
Created Date:  2011-01-10     Completed Date:  2011-05-03     Revised Date:  2013-07-03    
Medline Journal Info:
Nlm Unique ID:  100940729     Medline TA:  J Vasc Access     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  329-34     Citation Subset:  IM    
Affiliation:
Division of Vascular and Endovascular Surgery, University of California, San Francisco, CA 94143-0222, USA. Christopher.owens@ucsfmedctr.org
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Arteriovenous Shunt, Surgical* / adverse effects
Brachial Artery / physiopathology,  surgery*,  ultrasonography
Brachiocephalic Veins / physiopathology,  surgery*,  ultrasonography
Chronic Disease
Diabetes Mellitus / physiopathology
Endothelium, Vascular / physiopathology,  surgery*,  ultrasonography
Female
Humans
Kidney Diseases / physiopathology,  therapy*
Linear Models
Male
Middle Aged
Prospective Studies
Regional Blood Flow
Renal Dialysis*
Severity of Illness Index
Time Factors
Treatment Outcome
Vasodilation
Grant Support
ID/Acronym/Agency:
K23 HL 92163/HL/NHLBI NIH HHS; K23 HL092163-01/HL/NHLBI NIH HHS
Comments/Corrections

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