title: New Insights into Dialysis Vascular Access: Impact of Preexisting Arterial and Venous Pathology on AVF and AVG Outcomes.
abstract: Despite significant improvements in preoperative patient evaluation and surgical planning, vascular access failure in patients on hemodialysis remains a frequent and often unforeseeable complication. Our inability to prevent this complication is, in part, because of an incomplete understanding of how preexisting venous and arterial conditions influence the function of newly created arteriovenous fistulas and grafts. This article reviews the relationship between three preexisting vascular pathologies associated with CKD (intimal hyperplasia, vascular calcification, and medial fibrosis) and hemodialysis access outcomes. The published literature indicates that the pathogenesis of vascular access failure is multifactorial and not determined by any of these pathologies individually. Keeping this observation in mind should help focus our research on the true causes responsible for vascular access failure and the much needed therapies to prevent it.
authors.affiliation: DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida; and.
authors.forename: Roberto I
authors.initials: RI
authors.lastname: Vazquez-Padron
authors.affiliation: Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Michael
authors.initials: M
authors.lastname: Allon
mesh_terms: D001166:Arteriovenous Shunt, Surgical; D005355:Fibrosis; D006801:Humans; D006965:Hyperplasia / Q000150:complications; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D006435:Renal Dialysis; D016896:Treatment Outcome; D017539:Tunica Intima / Q000473:pathology*; D017540:Tunica Media / Q000473:pathology*; D061205:Vascular Calcification / Q000150:complications*; D058017:Vascular Grafting
keywords: Chronic; Humans; Hyperplasia; Renal Insufficiency; Veins; arteries; arteriovenous fistula; arteriovenous graft; intimal hyperplasia; pre-existing pathologies; renal dialysis; vascular calcification; vascular fibrosis