title: New Developments in Our Understanding of Neointimal Hyperplasia.
abstract: The vascular access remains the lifeline for the hemodialysis patient. The most common etiology of vascular access dysfunction is venous stenosis at the vein-artery anastomosis in arteriovenous fistula and at the vein-graft anastomosis in arteriovenous grafts (AVG). This stenotic lesion is typically characterized on histology as aggressive venous neointimal hyperplasia in both arteriovenous fistula and AVG. In recent years, we have advanced our knowledge and understanding of neointimal hyperplasia in vascular access and begun testing several novel therapies. This article will (1) review recent developments in our understanding of the pathophysiology of neointimal hyperplasia development in AVG and fistula failure, (2) discuss atypical factors leading to neointimal hyperplasia development, (3) highlight key novel therapies that have been evaluated in clinical trials, and (4) discuss future opportunities and challenges to improve our understanding of vascular access dysfunction and translate this knowledge into novel and innovative therapies.
authors.affiliation: Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Birmingham Veterans Affairs Medical Center, Birmingham, AL; Section of Nephrology, Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudia Arabia. Electronic address: txlee@uab.edu.
authors.forename: Timmy
authors.initials: T
authors.lastname: Lee
authors.affiliation: Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Birmingham Veterans Affairs Medical Center, Birmingham, AL; Section of Nephrology, Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudia Arabia.
authors.forename: Naveed
authors.initials: N
authors.lastname: Ul Haq
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000379:methods; D002404:Catheterization; D003251:Constriction, Pathologic / Q000473:pathology* / Q000503:physiopathology; D004730:Endothelium, Vascular / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D006965:Hyperplasia / Q000473:pathology* / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000628:therapy; D058426:Neointima / Q000473:pathology* / Q000503:physiopathology; D011183:Postoperative Complications / Q000473:pathology* / Q000503:physiopathology; D006435:Renal Dialysis; D058017:Vascular Grafting / Q000379:methods; D066253:Vascular Remodeling; D014680:Veins / Q000473:pathology* / Q000503:physiopathology
keywords: Arteriovenous accesses; Cannulation; Neointimal hyperplasia; Novel therapies; Vascular remodeling