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.

功能良好的动静脉瘘是慢性血液透析的首选血管通道。在 最近的DAC瘘研究我们和其他人观察到，只有不到16％的手术产生了瘘管 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 瘘管创造后成功的主要障碍是成功的主要障碍。该建议将解决 关于瘘管成熟的知识的基本差距。该提议的主要假设是 上部动脉和静脉循环的解剖和功能异常的结合 第4期和5期慢性肾脏疾病患者的AV瘘成熟失败预测。我们 提出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 血管扩张性和内皮依赖性血管舒张。此外，我们提出了增强 交感神经介导的血管收缩是另一个导致瘘管成熟失败的因素 防止正在发展的AV瘘中所需的血流大量增加。测试这些假设 我们将对慢性肾脏患者的瘘管成熟进行前瞻性观察性研究 疾病。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，血液流动和血管进行详细的术前评估 钙化以识别瘘管成熟的术前预测指标。最后，瘘管创造后的早期，我们将 评估瘘管解剖结构，血流和体格检查结果，以发展早期疗效 瘘管成熟受损的预测因素。从本提案中从研究中获得的知识将有助于 改善患者选择AV瘘的创建，识别成熟的关键解剖和功能性预测指标 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绝对是为维持生命的治疗的必要性 血液透析的患者AV瘘是透析的最佳血管访问类型，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，以便将来可以实施适当的改善成功干预措施。