Does Vascular Elasticity Affect Arteriovenous Fistula Maturation?

摘要

The vasculopathy of ESRD affects both arteries and veins. The arteries develop arteriosclerosis, which islargely a disease of the media characterized by increased collagen content, calcification, and both hypertrophy andhyperplasia of vascular smooth muscle cells. Veins may exhibit increased width of the intimal and medial layers, and maydevelop neointimal hyperplasia and calcification. Successful fistula maturation depends upon dilatation and remodeling ofthe artery and vein, but the stiff and thickened vessels of ESRD patients may respond poorly to signals that promote theseadaptations. There is intense interest in accurately predicting fistula maturation outcome and preventing maturationfailure. However, definitive criteria for preoperative testing of vessel elasticity have not yet been established. Tests thatare adopted for widespread clinical use will need to be easy to apply - a standard that many of these tests may not meet.Finally, effective treatments are needed that prevent or reduce the stiffness of vessels. In conclusion, although there aremany promising developments in this emerging field, effective methods of predicting fistula maturation outcome andpreventing maturation failure remain to be established.