title: Natural history of venous morphologic changes in dialysis access stenosis.
abstract: OBJECTIVE
  Venous stenosis secondary to neointimal hyperplasia is a major etiology of early arteriovenous fistula (AVF) failure. The natural history of AVF failure is likely influenced by progressive vascular insults to the vein prior to and after AVF creation. The main objectives of this study were to (1) provide a histologic and morphometric description of non-chronic kidney disease (CKD), upper extremity vein specimens and (2) perform a morphometric analysis to study venous histology from non-CKD upper extremity veins, veins collected at the time of new vascular access surgery and veins collected from failed stenotic AVFs.
  
  
  METHODS
  Vein samples from 11 non-CKD deceased donors, 29 subjects receiving new vascular access creation and 20 subjects with stenotic failed AVFs were collected for histologic and morphometric analysis.
  
  
  RESULTS
  The mean values of average intima/media thickness ± S.E. from veins collected from non-CKD subjects, subjects receiving new vascular access and subjects with stenotic AVFs were 0.16±0.02, 0.43±0.07 and 3.84±0.55, respectively (p<0.0001). Among donor, non-CKD, vein samples, only diabetes (p=0.0007) was associated with increased average intima/media thickness.
  
  
  CONCLUSIONS
  Our results demonstrate a progressively increasing venous neointimal hyperplasia development from the non-CKD period through the period of AVF creation and failure. Vascular injuries from complications of progressive CKD prior to access placement and vascular injuries after vascular access placement may play important roles in these progressive vascular changes, and need to be further elucidated.
authors: 4 Cincinnati Veterans Administration Medical Center, Cincinnati, OH - USA.
authors: Timmy
authors: T
authors: Lee
authors: Maheshika
authors: M
authors: Somarathna
authors: Arjan
authors: A
authors: Hura
authors: Yang
authors: Y
authors: Wang
authors: Begona
authors: B
authors: Campos
authors: Lois
authors: L
authors: Arend
authors: Rino
authors: R
authors: Munda
authors: Prabir
authors: P
authors: Roy-Chaudhury
mesh_terms: D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D016022:Case-Control Studies; D003251:Constriction, Pathologic; D018450:Disease Progression; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D006965:Hyperplasia; D007674:Kidney Diseases / Q000150:complications / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D058426:Neointima; D006435:Renal Dialysis; D012307:Risk Factors; D013997:Time Factors; D034941:Upper Extremity / Q000098:blood supply*; D014654:Vascular Patency; D066253:Vascular Remodeling; D014680:Veins / Q000473:pathology / Q000503:physiopathology / Q000601:surgery