title: Severe venous neointimal hyperplasia prior to dialysis access surgery.
abstract: BACKGROUND
  Venous neointimal hyperplasia is the most common cause of arteriovenous (AV) fistula and graft dysfunction following dialysis access surgery. However, the pathogenetic impact of pre-existing venous neointimal hyperplasia at the time of AV access creation on final clinical success is currently unknown in the setting of advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients. The aim of this study was to perform a detailed histological, morphometric, and immunohistochemical analysis of vein specimens in advanced CKD and ESRD patients collected at the time of new vascular access placement.
  
  
  METHODS
  Vein samples from 12 patients were collected at the time of AV access creation near the site of AV anastomosis. Histological, immunohistochemistry and morphometric studies were performed on these vein samples.
  
  
  RESULTS
  Examination of the tissue specimens obtained at the time of surgery showed neointimal hyperplasia in 10 of 12 specimens, ranging from minimal to very severe. The majority of cells within the neointima were myofibroblasts with a minority of contractile smooth muscle cells present.
  
  
  CONCLUSIONS
  Our work represents a detailed description of the morphometric and cellular phenotypic lesions present in the veins of CKD and ESRD patients, prior to dialysis access placement. These studies (i) suggest the future possibility of a new predictive marker (pre-existing venous neointimal hyperplasia) for AV dialysis access dysfunction and (ii) open the door for the future development of novel local therapies for optimization of the venous substrate on which the dialysis access is created.
authors.affiliation: Department of Clinical and Experimental Medicine, Federico II University Medical School, Naples, Italy. timmy.lee@uc.edu
authors.forename: Timmy
authors.initials: T
authors.lastname: Lee
authors.forename: Vibha
authors.initials: V
authors.lastname: Chauhan
authors.forename: Mahesh
authors.initials: M
authors.lastname: Krishnamoorthy
authors.forename: Yang
authors.initials: Y
authors.lastname: Wang
authors.forename: Lois
authors.initials: L
authors.lastname: Arend
authors.forename: Meenakshi J
authors.initials: MJ
authors.lastname: Mistry
authors.forename: Mahmoud
authors.initials: M
authors.lastname: El-Khatib
authors.forename: Rupak
authors.initials: R
authors.lastname: Banerjee
authors.forename: Rino
authors.initials: R
authors.lastname: Munda
authors.forename: Prabir
authors.initials: P
authors.lastname: Roy-Chaudhury
mesh_terms: D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D003251:Constriction, Pathologic; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006965:Hyperplasia / Q000209:etiology*; D007124:Immunoenzyme Techniques; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery*; D007677:Kidney Function Tests; D008297:Male; D058628:Myofibroblasts / Q000473:pathology; D011379:Prognosis; D006435:Renal Dialysis; D012307:Risk Factors; D017539:Tunica Intima / Q000473:pathology*; D014680:Veins / Q000473:pathology*