Vascular access-related thrombotic complications: research hypotheses and therapeutic strategies.
The most common complication of permanent vascular access is thrombosis, which accounts for 80 to 85% of AV access loss. Treatment of venous stenosis by percutaneous angioplasty, endovascular stents and surgical revision is clinically important but many strategies to prevent thrombosis have been employed, such as antiplatelet agents, systemic anticoagulation, and experimental therapies as fish oils, heparinoids, clopidogrel, renin-angiotensin system antagonists, calcium channel blockers, alpha adrenergic antagonists, homocysteine-lowering agents and beta-hydroxybetamethyglutaryl coenzyme-A reductase inhibitors. Future but promising approaches are endovascular radiation and gene therapy.
Bruno
Simona
S
Department of Medicine and Transplantation, Azienda Ospedaliera, Ospedali Riuniti di Bergamo, Bergamo, Italy. bruno@marionegri.it
Remuzzi
Giuseppe
G
D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D003251:Constriction, Pathologic / Q000209:etiology / Q000628:therapy; D006801:Humans; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000628:therapy; D020246:Venous Thrombosis / Q000209:etiology* / Q000628:therapy*