Intimal Hyperplasia and Arteriovenous Fistula Failure: Looking Beyond Size Differences.
Intimal Hyperplasia and Arteriovenous Fistula Failure: Looking Beyond Size Differences.
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DOI：
10.34067/kid.0002022021
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发表时间：
2021-08
期刊：
影响因子：
--
通讯作者：
Martinez L
中科院分区：
文献类型：
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作者：
Vazquez-Padron RI;Duque JC;Tabbara M;Salman LH;Martinez L
静脉内膜增生（IH）的发生历来与用于血液透析的动静脉内瘘（AVF）失败相关。这种基于组织学观察的长期假设最近受到临床研究的挑战，表明内膜本身的大小不足以解释狭窄或AVF成熟失败。尽管缺乏相关性，但IH存在于大多数自体静脉和瘘管中，在许多情况下很突出，并表明其在静脉中的作用可能无法通过其尺寸反映出来。因此，IH对AVF功能障碍的贡献仍然存在争议。仅使用临床数据，避免从动物模型外推，我们批判性地讨论了IH在静脉重塑，血管通路功能，以及血液透析患者静脉壁对重复创伤的反应中的生物学意义。我们解决的问题，并提出新的，如：是什么因素，有助于IH预接入静脉和AVF？内膜的细胞表型和组成是否影响AVF功能？静脉内膜是否有保护作用？本综述探讨了这些可能性，希望重新点燃关于静脉IH的批判性讨论，超越厚度和AVF结果。
The development of venous intimal hyperplasia (IH) has been historically associated with failure of arteriovenous fistulas (AVF) used for hemodialysis. This long-standing assumption, based on histological observations, has been recently challenged by clinical studies indicating that the size of the intima by itself is not enough to explain stenosis or AVF maturation failure. Irrespective of this lack of association, IH is present in most native veins and fistulas, is prominent in many cases, and suggests a role in the vein that may not be reflected by its dimensions. Therefore, the contribution of IH to AVF dysfunction remains controversial. Using only clinical data and avoiding extrapolations from animal models, we critically discuss the biological significance of IH in vein remodeling, vascular access function, and the response of the venous wall to repeated trauma in hemodialysis patients. We address questions and pose new ones such as: What are the factors that contribute to IH in pre-access veins and AVFs? Do cellular phenotypes and composition of the intima influence AVF function? Are there protective roles of the venous intima? This review explores these possibilities, with hopes of rekindling a critical discussion about venous IH that goes beyond thickness and AVF outcomes.