title: Novel paradigms for dialysis vascular access: downstream vascular biology--is there a final common pathway?
abstract: Vascular access dysfunction is a major cause of morbidity and mortality in hemodialysis patients. The most common cause of vascular access dysfunction is venous stenosis from neointimal hyperplasia within the perianastomotic region of an arteriovenous fistula and at the graft-vein anastomosis of an arteriovenous graft. There have been few, if any, effective treatments for vascular access dysfunction because of the limited understanding of the pathophysiology of venous neointimal hyperplasia formation. This review will (1) describe the histopathologic features of hemodialysis access stenosis; (2) discuss novel concepts in the pathogenesis of neointimal hyperplasia development, focusing on downstream vascular biology; (3) highlight future novel therapies for treating downstream biology; and (4) discuss future research areas to improve our understanding of downstream biology and neointimal hyperplasia development.
authors.affiliation: Department of Internal Medicine, Division of Nephrology and Hypertension, University of Cincinnati, Cincinatti, Ohio;, †Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio;, ‡Dialysis Vascular Access Research Group, Cincinnati, Ohio, §Department of Medicine, Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Timmy
authors.initials: T
authors.lastname: Lee
mesh_terms: D000818:Animals; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D003251:Constriction, Pathologic; D057510:Endovascular Procedures; D006083:Graft Occlusion, Vascular / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D006965:Hyperplasia; D058426:Neointima; D012039:Regional Blood Flow; D006435:Renal Dialysis; D012307:Risk Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D057772:Vascular System Injuries / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy