BACKGROUND: Venous neointimal hyperplasia is the most common cause of arteriovenous (AV) fistula and graft dysfunction following dialysis access surgery. However, the pathogenetic impact of pre-existing venous neointimal hyperplasia at the time of AV access creation on final clinical success is currently unknown in the setting of advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients. The aim of this study was to perform a detailed histological, morphometric, and immunohistochemical analysis of vein specimens in advanced CKD and ESRD patients collected at the time of new vascular access placement. METHODS: Vein samples from 12 patients were collected at the time of AV access creation near the site of AV anastomosis. Histological, immunohistochemistry and morphometric studies were performed on these vein samples. RESULTS: Examination of the tissue specimens obtained at the time of surgery showed neointimal hyperplasia in 10 of 12 specimens, ranging from minimal to very severe. The majority of cells within the neointima were myofibroblasts with a minority of contractile smooth muscle cells present. CONCLUSION: Our work represents a detailed description of the morphometric and cellular phenotypic lesions present in the veins of CKD and ESRD patients, prior to dialysis access placement. These studies (i) suggest the future possibility of a new predictive marker (pre-existing venous neointimal hyperplasia) for AV dialysis access dysfunction and (ii) open the door for the future development of novel local therapies for optimization of the venous substrate on which the dialysis access is created.
BACKGROUND:Venous neointimal hyperplasia is the most common cause of arteriovenous (AV) fistula and graft dysfunction following dialysis access surgery. However, the pathogenetic impact of pre-existing venous neointimal hyperplasia at the time of AV access creation on final clinical success is currently unknown in the setting of advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients. The aim of this study was to perform a detailed histological, morphometric, and immunohistochemical analysis of vein specimens in advanced CKD and ESRDpatients collected at the time of new vascular access placement. METHODS: Vein samples from 12 patients were collected at the time of AV access creation near the site of AV anastomosis. Histological, immunohistochemistry and morphometric studies were performed on these vein samples. RESULTS: Examination of the tissue specimens obtained at the time of surgery showed neointimal hyperplasia in 10 of 12 specimens, ranging from minimal to very severe. The majority of cells within the neointima were myofibroblasts with a minority of contractile smooth muscle cells present. CONCLUSION: Our work represents a detailed description of the morphometric and cellular phenotypic lesions present in the veins of CKD and ESRDpatients, prior to dialysis access placement. These studies (i) suggest the future possibility of a new predictive marker (pre-existing venous neointimal hyperplasia) for AV dialysis access dysfunction and (ii) open the door for the future development of novel local therapies for optimization of the venous substrate on which the dialysis access is created.
Authors: Bradley S Dixon; Gerald J Beck; Miguel A Vazquez; Arthur Greenberg; James A Delmez; Michael Allon; Laura M Dember; Jonathan Himmelfarb; Jennifer J Gassman; Tom Greene; Milena K Radeva; Ingemar J Davidson; T Alp Ikizler; Gregory L Braden; Andrew Z Fenves; James S Kaufman; James R Cotton; Kevin J Martin; James W McNeil; Asif Rahman; Jeffery H Lawson; James F Whiting; Bo Hu; Catherine M Meyers; John W Kusek; Harold I Feldman Journal: N Engl J Med Date: 2009-05-21 Impact factor: 91.245
Authors: Taku Kokubo; Noriyuki Ishikawa; Hisashi Uchida; Sara E Chasnoff; Xun Xie; Suresh Mathew; Keith A Hruska; Eric T Choi Journal: J Am Soc Nephrol Date: 2009-05-07 Impact factor: 10.121
Authors: Sun Hyung Kwon; Li Li; Yuxia He; Chieh Sheng Tey; Huan Li; Ilya Zhuplatov; Seung-Jung Kim; Christi M Terry; Donald K Blumenthal; Yan-Ting Shiu; Alfred K Cheung Journal: J Vasc Res Date: 2016-01-21 Impact factor: 1.934
Authors: Laura M Dember; Peter B Imrey; Gerald J Beck; Alfred K Cheung; Jonathan Himmelfarb; Thomas S Huber; John W Kusek; Prabir Roy-Chaudhury; Miguel A Vazquez; Charles E Alpers; Michelle L Robbin; Joseph A Vita; Tom Greene; Jennifer J Gassman; Harold I Feldman Journal: Am J Kidney Dis Date: 2013-08-28 Impact factor: 8.860
Authors: Alfred K Cheung; Peter B Imrey; Charles E Alpers; Michelle L Robbin; Milena Radeva; Brett Larive; Yan-Ting Shiu; Michael Allon; Laura M Dember; Tom Greene; Jonathan Himmelfarb; Prabir Roy-Chaudhury; Christi M Terry; Miguel A Vazquez; John W Kusek; Harold I Feldman Journal: J Am Soc Nephrol Date: 2017-07-14 Impact factor: 10.121
Authors: Charles E Alpers; Peter B Imrey; Kelly L Hudkins; Tomasz A Wietecha; Milena Radeva; Michael Allon; Alfred K Cheung; Laura M Dember; Prabir Roy-Chaudhury; Yan-Ting Shiu; Christi M Terry; Alik Farber; Gerald J Beck; Harold I Feldman; John W Kusek; Jonathan Himmelfarb Journal: J Am Soc Nephrol Date: 2017-07-19 Impact factor: 10.121