The effect of flow changes on the arterial system proximal to an arteriovenous fistula for hemodialysis.
Arterial remodeling in response to flow changes is controlled by the endothelium, sensing wall shear stress (SS) changes. The present study focuses on the remodeling capacities of the brachial (BA) and radial artery (RA) of 16 renal failure patients after arteriovenous fistula creation. Pre- and postoperatively at predetermined time-points, diameter, wall thickness and peak and mean SS were assessed. After arteriovenous fistula creation, acute increases in BA SS (p = 0.018) and lumen diameter (p = 0.028) were observed. The diameter further increased in the next year (p = 0.023), whereas BA SS remained unchanged. RA SS and diameter increased acutely (p = 0.005) and remained unaltered after 1 y. RA wall thickness tended to decrease acutely (p = 0.059) and increased steadily during 1 y (p = 0.008). BA and RA diameter acutely increased after an acute SS rise and remained augmented after 1 y. Also, the RA vessel wall thickness enlarged, indicating structural remodeling. After 1 y, however, these changes did not result in SS restoration.
Dammers
Ruben
R
Department of Surgery, University Hospital Maastricht, Maastricht, The Netherlands.
Tordoir
Jan H M
JH
Kooman
Jeroen P
JP
Welten
Rob J Th J
RJ
Hameleers
Jeroen M M
JM
Kitslaar
Peter J E H M
PJ
Hoeks
Arnold P G
AP
D000368:Aged; D001166:Arteriovenous Shunt, Surgical; D001783:Blood Flow Velocity; D001809:Blood Viscosity; D001916:Brachial Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D018056:Hemorheology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D017534:Radial Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012039:Regional Blood Flow; D006435:Renal Dialysis; D013314:Stress, Mechanical; D017539:Tunica Intima / Q000000981:diagnostic imaging*; D014463:Ultrasonography