title: Advances and new frontiers in the pathophysiology of venous neointimal hyperplasia and dialysis access stenosis.
abstract: Hemodialysis vascular access dysfunction is a major cause of morbidity and mortality in hemodialysis patients. The most common cause of this vascular access dysfunction is venous stenosis as a result of venous neointimal hyperplasia within the perianastomotic region (arteriovenous fistula) or at the graft-vein anastomosis (polytetrafluoroethylene, or PTFE, grafts). There have been few effective treatments to date for venous neointimal hyperplasia, in part, because of the poor understanding of the pathogenesis of venous neointimal hyperplasia. Therefore, this article will (1) describe the pathology of hemodialysis access stenosis in arteriovenous fistulas and grafts, (2) review and describe both current and novel concepts in the pathogenesis of neointimal hyperplasia formation, (3) discuss current and future novel therapies for treating venous neointimal hyperplasia, and (4) suggest future research areas in the field of hemodialysis vascular access dysfunction.
authors.affiliation: Department of Internal Medicine and Division of Nephrology and Hypertension, University of Cincinnati, Cincinnati, OH 45267-0585, USA. timmy.lee@uc.edu
authors.forename: Timmy
authors.initials: T
authors.lastname: Lee
authors.forename: Prabir
authors.initials: P
authors.lastname: Roy-Chaudhury
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D003251:Constriction, Pathologic / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D006965:Hyperplasia / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D018384:Oxidative Stress; D006435:Renal Dialysis; D017539:Tunica Intima / Q000473:pathology* / Q000503:physiopathology*; D014680:Veins / Q000473:pathology* / Q000503:physiopathology*
references.citation: J Vasc Interv Radiol. 2009 Feb;20(2):241-51
references.pmid: 19028119
references.citation: Nephrol Dial Transplant. 2000 Dec;15(12):2029-36
references.pmid: 11096150
references.citation: J Nephrol. 2004 Jul-Aug;17(4):512-9
references.pmid: 15372412
references.citation: Circulation. 1996 Jun 15;93(12):2178-87
references.pmid: 8925587
references.citation: Kidney Int. 2006 Oct;70(8):1413-22
references.pmid: 16883317
references.citation: Nephrol Dial Transplant. 2007 Nov;22(11):3139-46
references.pmid: 17602194
references.citation: J Korean Med Sci. 2006 Apr;21(2):284-9
references.pmid: 16614515
references.citation: Chin Med J (Engl). 2008 Nov 5;121(21):2157-61
references.pmid: 19080177
references.citation: Nephrol Dial Transplant. 2001 Jun;16(6):1189-97
references.pmid: 11390719
references.citation: J Am Soc Nephrol. 1996 Apr;7(4):523-35
references.pmid: 8724885
references.citation: J Vasc Surg. 2007 May;45(5):1029-1037; discussion 1037-8
references.pmid: 17466798
references.citation: JAMA. 2008 May 14;299(18):2164-71
references.pmid: 18477783
references.citation: Kidney Int. 2001 Jun;59(6):2325-34
references.pmid: 11380837
references.citation: Circ Res. 2000 Apr 28;86(8):879-84
references.pmid: 10785510
references.citation: Am J Pathol. 2008 Mar;172(3):839-48
references.pmid: 18276778
references.citation: Clin Trials. 2005;2(5):400-12
references.pmid: 16317809
references.citation: Curr Opin Nephrol Hypertens. 2008 Nov;17(6):609-15
references.pmid: 18941355
references.citation: Ann Thorac Cardiovasc Surg. 2006 Oct;12(5):341-8
references.pmid: 17095976
references.citation: Nephrol Dial Transplant. 2009 Sep;24(9):2786-91
references.pmid: 19377054
references.citation: Am J Kidney Dis. 1999 Oct;34(4):702-5
references.pmid: 10516352
references.citation: Circulation. 2003 Feb 25;107(7):992-5
references.pmid: 12600912
references.citation: Am J Kidney Dis. 2004 Jan;43(1):74-84
references.pmid: 14712430
references.citation: Kidney Int. 2002 Mar;61(3):1011-9
references.pmid: 11849456
references.citation: J Am Soc Nephrol. 2009 Jun;20(6):1236-45
references.pmid: 19423694
references.citation: Circulation. 1996 Oct 1;94(7):1655-64
references.pmid: 8840858
references.citation: J Vasc Interv Radiol. 2008 Feb;19(2 Pt 1):252-9
references.pmid: 18341958
references.citation: J Vasc Surg. 2007 Sep;46(3):548-556
references.pmid: 17826244
references.citation: Circulation. 1997 Jun 17;95(12):2684-93
references.pmid: 9193438
references.citation: Circulation. 2000 Oct 31;102(18):2262-8
references.pmid: 11056103
references.citation: Am J Kidney Dis. 2007 Nov;50(5):782-90
references.pmid: 17954291
references.citation: Kidney Int. 2008 Jul;74(1):47-51
references.pmid: 18368029
references.citation: Blood Purif. 2002;20(5):469-72
references.pmid: 12207095
references.citation: Kidney Int. 2006 Jul;70(2):315-20
references.pmid: 16760906
references.citation: Kidney Int. 2008 Aug;74(4):528-31
references.pmid: 18509320
references.citation: Kidney Int. 2006 Jan;69(1):165-72
references.pmid: 16374439
references.citation: Kidney Int. 1997 Dec;52(6):1478-85
references.pmid: 9407493
references.citation: J Vasc Res. 2002 Nov-Dec;39(6):524-33
references.pmid: 12566978
references.citation: Cardiovasc Res. 2006 Jul 15;71(2):269-79
references.pmid: 16780820
references.citation: Am J Physiol Heart Circ Physiol. 2008 May;294(5):H2219-30
references.pmid: 18326810
references.citation: Kidney Int. 2006 Aug;70(3):432-43
references.pmid: 16775600
references.citation: J Am Soc Nephrol. 2006 Apr;17(4):1112-27
references.pmid: 16565259
references.citation: Kidney Int. 2005 May;67(5):1986-92
references.pmid: 15840048
references.citation: N Engl J Med. 2009 May 21;360(21):2191-201
references.pmid: 19458364
references.citation: Am J Physiol Renal Physiol. 2007 Aug;293(2):F470-5
references.pmid: 17344190
references.citation: Kidney Int. 2002 Nov;62(5):1524-38
references.pmid: 12371953
references.citation: J Am Soc Nephrol. 2009 Jan;20(1):213-22
references.pmid: 19118151
references.citation: Am J Kidney Dis. 2001 May;37(5):970-80
references.pmid: 11325679
references.citation: Circ Res. 2005 Sep 16;97(6):533-40
references.pmid: 16109921
references.citation: Nephrol Dial Transplant. 2008 Feb;23(2):525-33
references.pmid: 18037619
references.citation: Kidney Int. 2005 Dec;68(6):2890-900
references.pmid: 16316367
references.citation: Nephrol Dial Transplant. 2006 Sep;21(9):2425-31
references.pmid: 16822794
references.citation: Arterioscler Thromb Vasc Biol. 2000 Dec;20(12):E120-6
references.pmid: 11116076
references.citation: Arterioscler Thromb Vasc Biol. 2000 Sep;20(9):2032-7
references.pmid: 10978245
references.citation: Nephrol Dial Transplant. 2006 Mar;21(3):715-20
references.pmid: 16249200
references.citation: Kidney Int. 2003 Oct;64(4):1487-94
references.pmid: 12969170
references.citation: Kidney Int. 2002 Dec;62(6):2272-80
references.pmid: 12427156
references.citation: J Vasc Surg. 2004 Feb;39(2):432-9
references.pmid: 14743149
references.citation: Nephron. 2002 Jul;91(3):456-62
references.pmid: 12119477
references.citation: J Nephrol. 2007 Mar-Apr;20(2):150-63
references.pmid: 17514619