Neointimal hyperplasia in early arteriovenous fistula failure.
BACKGROUND
Hemodialysis vascular access dysfunction currently is a huge clinical problem. Although arteriovenous fistulas (AVFs) are the preferred form of permanent dialysis access, they continue to have significant problems with early AVF failure. Although inadequate dilatation of the venous segment was believed to have a role in early AVF failure, the exact pathogenesis of early AVF failure is unknown despite the magnitude of the clinical problem.


METHODS
Case series.


METHODS
Hemodialysis patients.


METHODS
Stenotic venous segments from 4 patients with early AVF failure were subjected to a detailed histological, morphometric, and immunohistochemical analysis.


RESULTS
All 4 patients had significant luminal stenosis, primarily as a result of eccentric neointimal hyperplasia. This was confirmed through morphometric analysis, which documented intima-media area and thickness ratios that were greater than unity. Cellular phenotyping studies showed that the majority of cells within the region of neointimal hyperplasia were myofibroblasts, with smaller numbers of contractile smooth muscle cells.


CONCLUSIONS
We described only a limited number of specimens.


CONCLUSIONS
We show for the first time that aggressive neointimal hyperplasia is present in venous segment specimens from patients with early AVF failure. Future therapies to address this problem will need to target this pathogenetic pathway.
Roy-Chaudhury
Prabir
P
Department of Medicine, Division of Nephrology, Cincinnati Dialysis Access Research Program, University of Cincinnati, Cincinnati, OH 45267-0585, USA. prabir.roychaudhury@uc.edu
Arend
Lois
L
Zhang
Jianhua
J
Krishnamoorthy
Mahesh
M
Wang
Yang
Y
Banerjee
Rupak
R
Samaha
Antoine
A
Munda
Rino
R
D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical; D005260:Female; D006083:Graft Occlusion, Vascular / Q000473:pathology*; D006801:Humans; D006965:Hyperplasia; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D017539:Tunica Intima / Q000473:pathology*