Document Detail

Long-term arterial adaptation to high blood flow in the feeding artery of vascular access for hemodialysis.
MedLine Citation:
PMID:  22266594     Owner:  NLM     Status:  MEDLINE    
PURPOSE: Arteries continuously respond to changing tissue demands and to hemodynamic conditions by altering their diameter and wall structure. The relatively slow dilatation of the feeding artery of vascular accesses continues at least two years after access creation with a continuous decrease in wall shear rate (WSR), which however, remains highly supra-physiological. The aim of this study was to test the hypothesis that after a longer time period the WSR returns to its baseline value.
METHODS: In a cross-sectional study patients with arteriovenous fistulae were classified into four groups according to the access vintage (from new access to accesses older than six years). The WSR, cross-sectional area, and mean circumferential wall stress were measured and compared between groups.
RESULTS: WSR decreased from group 1 (fistula < ninety days old) to group 4 (fistulae > six years old) with a concomitant increase in internal diameter. Patients with the oldest access had normal WSR values (compared to the contralateral brachial artery) and the largest internal diameter of the feeding artery. In diabetic patients the absolute values of WSR were higher and internal diameter was lower compared to nondiabetic patients.
CONCLUSIONS: Brachial artery WSR is normal in accesses older than six years with an increased internal diameter and wall cross-sectional area as compared to "younger" accesses. This suggests a process of vascular remodeling with an increase in vascular wall mass and normalization of WSR to physiologic values at the price of increased mean cross-sectional wall stress.
Vladimir Tuka; Jan Malik; Eva Chytilova; Jaroslav Kudlicka; Marcela Slavikova; Edwin Wijnen; Jan H M Tordoir; Simon Van Hooland
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The journal of vascular access     Volume:  13     ISSN:  1724-6032     ISO Abbreviation:  J Vasc Access     Publication Date:    2012 Jul-Sep
Date Detail:
Created Date:  2012-10-01     Completed Date:  2013-03-01     Revised Date:  2014-07-31    
Medline Journal Info:
Nlm Unique ID:  100940729     Medline TA:  J Vasc Access     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  305-9     Citation Subset:  IM    
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MeSH Terms
Adaptation, Physiological
Aged, 80 and over
Arteriovenous Shunt, Surgical*
Blood Flow Velocity
Brachial Artery / pathology,  physiopathology*,  ultrasonography
Chi-Square Distribution
Cross-Sectional Studies
Linear Models
Middle Aged
Multivariate Analysis
Regional Blood Flow*
Renal Dialysis*
Stress, Mechanical
Time Factors
Upper Extremity / blood supply*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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