Anatomic and functional predictors of arteriovenous fistula maturation

动静脉内瘘成熟的解剖学和功能预测因素

• 批准号: 8326563
• 负责人: MIGUEL A VAZQUEZ
• 金额: $ 20.9万
• 依托单位: UT SOUTHWESTERN MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-10 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8326563
• 关键词: Address; Anatomy; Applications Grants; Arteries; Arteriovenous fistula; Auscultation; Blood Circulation; Blood Flow Velocity; Blood Vessels; Blood flow; Caliber; Chronic; Chronic Kidney Failure; Clinical; Complex; Data; Dialysis procedure; Endothelium; Evaluation; Event; Failure; Fistula; Future; Genes; Hemodialysis; Histologic; Image; Institution; Intervention; Intervention Trial; Knowledge; Laboratories; Life; Measures; Mediating; National Institute of Diabetes and Digestive and Kidney Diseases; Natural History; Observational Study; Operative Surgical Procedures; Palpation; Patient Selection; Patients; Physical Examination; Physiologic pulse; Physiological; Population; Postoperative Period; Process; Recruitment Activity; Research Infrastructure; Research Personnel; Schedule; Staging; Stenosis; Stimulus; Structure; Subgroup; Techniques; Testing; Thrombosis; Time; United States National Institutes of Health; Upper Extremity; Vascular calcification; Vasodilation; Veins; Venous; arm; arterial stiffness; calcification; cohort; design; improved; novel; prevent; programs; prospective; response; success; vasoconstriction

DESCRIPTION (provided by applicant): A well functioning arteriovenous fistula is the preferred type of vascular access for chronic hemodialysis. In the recent DAC fistula studies we and others observed that fewer than 16% of surgically created fistulas failed due to thrombosis but more than 60% of fistulas failed to reach suitability for dialysis, confirming that impaired maturation is the main obstacle to success after fistula creation. This proposal will address fundamental gaps in knowledge about fistula maturation. The main hypothesis of this proposal is that a combination of anatomic and functional abnormalities of the arterial and venous circulations of the upper extremities predict AV fistula maturation failure in patients with stage 4 and 5 chronic kidney disease. We submit that studies of vascular structure and function can be used to predict fistula maturation. We further hypothesize that vascular calcification in the arm predisposes to fistula maturation failure by impairing vascular distensibility and endothelium-dependent vasodilation. In addition, we propose that augmented sympathetic-mediated vasoconstriction is another factor that contributes to maturation failure of fistulas by preventing the large increases in blood flow necessary in a developing AV fistula. To test these hypotheses we will conduct a prospective observational study of fistula maturation in patients with chronic kidney disease. We will define the natural history of fistula maturation and related clinical and surgical events. We will perform a detailed preoperative evaluation of vessel anatomy, blood flow to the arm and vascular calcifications to identify preoperative predictors of fistula maturation. Finally, early after fistula creation we will evaluate fistula anatomy, blood flow and physical examination findings to develop early postoperative predictors of impaired fistula maturation. Knowledge obtained from the studies in this proposal will help to improve patient selection for AV fistula creation, identify key anatomic and functional predictors of maturation failure, and provide valid data for future intervention trials to promote fistula maturation. A well functioning vascular access is an absolute necessity to provide life-sustaining treatments for patients on hemodialysis AV fistulas are the best type of vascular access for dialysis, but unfortunately, most fistulas fail to develop adequately to sustain dialysis treatments. This proposal aims to identify predictors of fistula failure so that appropriate interventions to improve success can be implemented in the future.

描述（由申请人提供）： 功能良好的动静脉瘘是慢性血液透析的首选血管通道。在最近的DAC瘘管研究中，我们和其他人观察到，由于血栓形成，不到16％的手术产生的瘘管失败了，但超过60％的瘘管未能达到透析的适用性，证实了这种不受欢迎的成熟是创造后成功的主要障碍。该提案将解决有关瘘管成熟的知识的基本差距。该提议的主要假设是，上肢的动脉和静脉循环的解剖和功能异常的组合可以预测4阶段4和5期慢性肾脏疾病患者的AV瘘成熟失败。我们认为有关血管结构和功能的研究可用于预测瘘管成熟。我们进一步假设手臂中的血管钙化易受瘘管成熟的失败，通过损害血管扩张性和内皮依赖性血管舒张。此外，我们建议增强的交感神经介导的血管收缩是另一个因素，它通过防止发展中AV瘘所需的血流大量增加而导致瘘管的成熟失败。为了检验这些假设，我们将对患有慢性肾脏疾病患者的瘘管成熟进行前瞻性观察性研究。我们将定义瘘管成熟以及相关的临床和手术事件的自然史。我们将对血管解剖结构，血液流动和血管钙化进行详细的术前评估，以鉴定瘘管成熟的术前预测指标。最后，在瘘管产生后的早期，我们将评估瘘管解剖结构，血流和体格检查发现，以发展瘘管成熟受损的术后预测因子。从本提案中获得的研究获得的知识将有助于改善患者的AV瘘创建，确定关键的解剖和功能性预测因子的成熟失败，并为将来的干预试验提供有效的数据以促进瘘管成熟。功能良好的血管通道是为血液透析AV瘘提供生命维持治疗的绝对必要性，是透析的最佳血管通道类型，但不幸的是，大多数瘘管无法充分发展以维持透析治疗。该建议旨在确定瘘管故障的预测因素，以便将来可以实施适当的改善成功干预措施。