Arteriovenous Conduits for Hemodialysis: How to Better Modulate the Pathophysiological Vascular Response to Optimize Vascular Access Durability.

Arteriovenous Conduits for Hemodialysis: How to Better Modulate the Pathophysiological Vascular Response to Optimize Vascular Access Durability. Am J Physiol Renal Physiol. 2019 Feb 20;: Authors: Shiu YT, Rotmans JI, Geelhoed WJ, Pike DB, Lee T Abstract Vascular access is the lifeline for hemodialysis patients. Arteriovenous fistulas (AVFs) are the preferred vascular access but AVF maturation failure remains a significant clinical problem. Currently there are not any effective therapies available to prevent or treat AVF maturation failure. AVF maturation failure frequently results from venous stenosis at the AVF anastomosis, which is secondary to poor outward vascular remodeling and excessive venous intimal hyperplasia that narrows the AVF lumen. Arteriovenous grafts (AVGs) are the next preferred vascular access if an AVF creation is not possible. AVG failure is primarily the result of venous stenosis at the vein-graft anastomosis, which originates from intimal hyperplasia development. While there has been advancement in our knowledge of the pathophysiology of AVF maturation and AVG failure, this has not translated into effective therapies for these two important clinical problems. Further work will be required to dissect out the mechanisms of AVF maturation failure and AVG failure to develop more specific therapies. This review highlights the major recent advancements in AVF and AVG biology, reviews major clinical trials, and discus...
Source: American Journal of Physiology. Renal Physiology - Category: Physiology Authors: Tags: Am J Physiol Renal Physiol Source Type: research