Severe venous neointimal hyperplasia prior to dialysis access surgery
Severe venous neointimal hyperplasia prior to dialysis access surgery
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DOI：
10.1093/ndt/gfq733
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发表时间：
2011-07-01
影响因子：
6.1
通讯作者：
Roy-Chaudhury, Prabir
中科院分区：
文献类型：
--
作者：
Lee, Timmy;Chauhan, Vibha;Roy-Chaudhury, Prabir
背景。静脉新生内膜增生是透析手术后引起动静脉瘘和移植物功能障碍的最常见原因。然而，在晚期慢性肾病（CKD）和终末期肾病（ESRD）患者中，AV通路形成时存在的静脉新生内膜增生对最终临床成功的发病影响目前尚不清楚。本研究的目的是对晚期CKD和ESRD患者在放置新血管通道时收集的静脉标本进行详细的组织学、形态计量学和免疫组织化学分析。12例患者的静脉样本采集于房室吻合部位附近的房室通道创建时。对这些静脉样本进行组织学、免疫组织化学和形态计量学研究。手术时获得的组织标本检查显示，12个标本中有10个有新生内膜增生，从轻微到非常严重。新生内膜内大部分细胞为肌成纤维细胞，有少量可收缩的平滑肌细胞。我们的工作详细描述了CKD和ESRD患者在透析通路放置之前静脉中存在的形态计量学和细胞表型病变。这些研究(i)提示了AV透析通路功能障碍的新预测标志物（预先存在的静脉新生内膜增生）的未来可能性，（ii）为未来开发新的局部治疗方法打开了大门，以优化创建透析通路的静脉基质。
Background. Venous neointimal hyperplasia is the most common cause of arteriovenous (AV) fistula and graft dysfunction following dialysis access surgery. However, the pathogenetic impact of pre-existing venous neointimal hyperplasia at the time of AV access creation on final clinical success is currently unknown in the setting of advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients. The aim of this study was to perform a detailed histological, morphometric, and immunohistochemical analysis of vein specimens in advanced CKD and ESRD patients collected at the time of new vascular access placement.Methods. Vein samples from 12 patients were collected at the time of AV access creation near the site of AV anastomosis. Histological, immunohistochemistry and morphometric studies were performed on these vein samples.Results. Examination of the tissue specimens obtained at the time of surgery showed neointimal hyperplasia in 10 of 12 specimens, ranging from minimal to very severe. The majority of cells within the neointima were myofibroblasts with a minority of contractile smooth muscle cells present.Conclusion. Our work represents a detailed description of the morphometric and cellular phenotypic lesions present in the veins of CKD and ESRD patients, prior to dialysis access placement. These studies (i) suggest the future possibility of a new predictive marker (pre-existing venous neointimal hyperplasia) for AV dialysis access dysfunction and (ii) open the door for the future development of novel local therapies for optimization of the venous substrate on which the dialysis access is created.