title: Arteriovenous access failure: more than just intimal hyperplasia?
abstract: Haemodialysis vascular access patency is severely compromised by fistula non-maturation and access stenosis. Intimal hyperplasia (IH) is considered the culprit lesion in failed fistulas, resulting in luminal narrowing and stenosis. This review focuses on the biology and pathophysiology of fistula failure and highlights not only the classically associated IH but also some relatively neglected but potentially important contributors such as inadequate outward remodelling. In addition, the complex process and fragile balance of successful fistula maturation might be partially hindered by pre-existent chronic kidney disease-mediated vasculopathy. Further unravelling the (patho)physiology of outward remodelling and IH could contribute to novel therapies and enhance fistula patency.
authors.affiliation: Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Tonia C
authors.initials: TC
authors.lastname: Rothuizen
authors.forename: Chunyu
authors.initials: C
authors.lastname: Wong
authors.forename: Paul H A
authors.initials: PH
authors.lastname: Quax
authors.forename: Anton Jan
authors.initials: AJ
authors.lastname: van Zonneveld
authors.forename: Ton J
authors.initials: TJ
authors.lastname: Rabelink
authors.forename: Joris I
authors.initials: JI
authors.lastname: Rotmans
mesh_terms: D000818:Animals; D001164:Arteriovenous Fistula / Q000473:pathology*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D006801:Humans; D006965:Hyperplasia / Q000473:pathology*; D017539:Tunica Intima / Q000473:pathology*; D014654:Vascular Patency
keywords: arteriovenous fistula; haemodialysis access; intimal hyperplasia; outward remodelling