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: 7899651
• 负责人: MIGUEL A VAZQUEZ
• 金额: $ 32.49万
• 依托单位: UT SOUTHWESTERN MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2012-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7899651
• 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; Kidney; 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; Upper Extremity; Upper arm; Vascular calcification; Vasodilation; Veins; Venous; arterial stiffness; calcification; cohort; design; improved; novel; prevent; programs; prospective; response; success; vasoconstriction

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 extemities 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 postperative 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.

功能良好的动静脉内瘘是长期血液透析的首选血管通路类型。在 我们和其他人最近的DAC瘘管研究观察到，手术产生的瘘管中， 由于血栓形成而失败，但超过60%的瘘管未能达到透析的适用性，证实 成熟受损是瘘管形成后成功的主要障碍。该提案将解决 关于瘘管成熟的知识存在根本性空白。该提案的主要假设是， 上肢动脉和静脉循环的解剖和功能异常的组合 在4期和5期慢性肾脏病患者中，外痔可预测动静脉瘘成熟失败。我们 提出血管结构和功能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倾向于通过损害 血管扩张性和内皮依赖性血管舒张。此外，我们建议， 交感神经介导的血管收缩是导致瘘管成熟失败的另一个因素， 防止发展中的AV瘘所必需的血流量的大幅增加。来验证这些假设 我们将对慢性肾脏病患者的瘘管成熟进行前瞻性观察研究， 疾病我们将定义瘘管成熟的自然史和相关的临床和手术事件。我们 将对血管解剖结构、手臂血流和血管进行详细的术前评估 钙化，以确定瘘成熟的术前预测因素。最后，在瘘管形成后的早期，我们将 评估瘘管解剖、血流和体格检查结果，以制定术后早期治疗方案。 瘘管成熟受损的预测因子。从本建议的研究中获得的知识将有助于 改善动静脉瘘创建的患者选择，确定成熟的关键解剖和功能预测因素 失败，并为未来的干预试验提供有效数据，以促进瘘管成熟。 一个功能良好的血管通路是绝对必要的，以提供生命维持治疗， 血液透析患者AV瘘是透析的最佳血管通路类型，但不幸的是， 瘘管不能充分发展以维持透析治疗。该提案旨在确定 因此，我们需要采取适当措施，以便在今后采取适当干预措施，提高瘘管病治疗的成功率。