Future research directions to improve fistula maturation and reduce access failure.
Future research directions to improve fistula maturation and reduce access failure.
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DOI：
10.1053/j.semvascsurg.2016.08.005
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发表时间：
2016-12
影响因子：
2.5
通讯作者：
Dardik A
中科院分区：
文献类型：
--
作者：
Hu H;Patel S;Hanisch JJ;Santana JM;Hashimoto T;Bai H;Kudze T;Foster TR;Guo J;Yatsula B;Tsui J;Dardik A
随着终末期肾脏疾病的日益流行，对血液透析的需求日益增长。动静脉瘘（AVF）是血液透析首选的血管通路类型，但成熟和失败仍然是成功使用瘘的重大障碍。在尿毒症、全身性炎症、氧化应激和先前存在的血管病理的情况下，AVF成熟结合了向外重构和血管壁增厚，以应对剧烈的血流动力学变化。AVF的失败可能是由于不能充分成熟以支持血液透析，以及新生内膜增生（NIH）的发展使AVF管腔变窄，通常在瘘吻合处附近。NIH导致的失败涉及血管细胞的激活和迁移以及细胞外基质的重塑，这些重塑与生长因子、粘附分子、炎症介质和趋化因子的复杂相互作用有关，所有这些都导致了适应性不良的重塑。基于目前对接入失败的模式和病理的理解，已经提出了预防和治疗AVF失败的不同策略；这些方法包括适当的患者选择和使用替代手术策略来创建瘘管，以及使用新的介入技术或药物来治疗失败的瘘管。预防或治疗AVF衰竭的有效治疗需要多学科的方法，包括肾病学家、血管外科医生和介入放射科医生，允许仔细选择患者，并使用量身定制的系统或局部干预措施，以改善患者的具体结果。这篇综述提供了AVF成熟和失败的潜在机制的当代信息，并讨论了针对特定治疗的广泛选择。
With the increasing prevalence of end stage renal disease there is a growing need for hemodialysis. Arteriovenous fistulae (AVF) are the preferred type of vascular access for hemodialysis but maturation and failure continue to present significant barriers to successful fistula use. AVF maturation integrates outward remodeling with vessel wall thickening in response to drastic hemodynamic changes, in the setting of uremia, systemic inflammation, oxidative stress and preexistent vascular pathology. AVF can fail due to both failure to mature adequately to support hemodialysis, as well as development of neointimal hyperplasia (NIH) that narrows the AVF lumen, typically near the fistula anastomosis. Failure due to NIH involves vascular cell activation and migration and extracellular matrix remodeling with complex interactions of growth factors, adhesion molecules, inflammatory mediators, and chemokines, all of which result in maladaptive remodeling. Different strategies have been proposed to prevent and treat AVF failure, based on current understanding of the modes and pathology of access failure; these approaches range from appropriate patient selection and use of alternative surgical strategies for fistula creation, to the use of novel interventional techniques or drugs to treat failing fistulae. Effective treatments to prevent or treat AVF failure requires a multidisciplinary approach involving nephrologists, vascular surgeons and interventional radiologists, allowing careful patient selection and the use of tailored systemic or localized interventions to improve patient-specific outcomes. This review provides contemporary information on the underlying mechanisms of AVF maturation and failure and discusses the broad spectrum of options that can be tailored for specific therapy.
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影响因子：
6.7
作者：
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通讯作者：
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影响因子：
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DOI：
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发表时间：
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影响因子：
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作者：
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通讯作者：
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作者：
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