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Article
Endothelial function predicts positive arterial-venous fistula remodeling in subjects with stage IV and V chronic kidney disease
Surgery Publications and Presentations
  • Christopher D. Owens, University of California, San Francisco
  • Nicole Wake, Brighams and Womens Hospital
  • Ji Min Kim, Brighams and Womens Hospital
  • Dirk Hentschel, Brighams and Womens Hospital
  • Michael S. Conte, Brighams and Womens Hospital
  • Andres Schanzer, University of Massachusetts Medical School
UMMS Affiliation
Department of Surgery
Date
11-3-2010
Document Type
Article
Medical Subject Headings
Arteriovenous Shunt, Surgical; Brachial Artery; Brachiocephalic Veins; Endothelium, Vascular; Kidney Diseases; Renal Dialysis
Disciplines
Abstract
Purpose: The maturation of an arteriovenous fistula (AVF) requires remodeling of the arterial inflow and the venous outflow limbs to sustain flows sufficient to support hemodialysis. However, factors influencing remodeling of AVF are poorly understood. We hypothesized that AVF remodeling was an endothelium-dependent process. Methods: This is a prospective cohort study of patients (n=25) undergoing autologous AVF formation. Brachial artery vasoreactivity studies were performed pre-operatively to assess endothelium-dependent, flow-mediated vasodilation (FMD). High-resolution ultrasound was used to assess venous and arterial diameters intraoperatively, and at 3 months. Results: The mean age was 64.5 +/- 13.6 yrs. Twelve patients (48%) had diabetes. The mean FMD for the entire cohort was (mean +/- SEM) 5.82 +/- 0.9%, (range) 0-17.3%. The vein increased in size 3.19 +/- .28 to 6.11 +/- .41 mm, 108.4 +/- 17.9%, p=.0001, while the artery increased from 3.29 +/- .14 to 4.48 +/- .30 mm, 20.47 +/- 10.8%, p=.013. There was a significant positive correlation between the degree of arterial and venous remodeling, r=.52, p=.023. Brachial artery FMD most strongly correlated with the magnitude of arterial remodeling, r=.47, p=.038. Patients with diabetes failed to undergo venous remodeling to the same extent as did those without diabetes, 59.2 +/- 24.4% vs. 141.5 +/- 25.4%, p=.04. Conclusion: Impairment of endothelial function is associated with decreased arterial remodeling and final venous lumen diameter attained at 3 months. Further investigation is needed to determine whether modulation of endothelial function in this cohort can improve AVF maturation.
Rights and Permissions
Citation: J Vasc Access. 2010 Oct-Dec;11(4):329-34.
Related Resources
Link to Article in PubMed
PubMed ID
21038305
Citation Information
Christopher D. Owens, Nicole Wake, Ji Min Kim, Dirk Hentschel, et al.. "Endothelial function predicts positive arterial-venous fistula remodeling in subjects with stage IV and V chronic kidney disease" Vol. 11 Iss. 4 (2010) ISSN: 1129-7298 (Linking)
Available at: http://works.bepress.com/andres_schanzer/21/