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, 11 (4), 329-34

Endothelial Function Predicts Positive Arterial-Venous Fistula Remodeling in Subjects With Stage IV and V Chronic Kidney Disease

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Endothelial Function Predicts Positive Arterial-Venous Fistula Remodeling in Subjects With Stage IV and V Chronic Kidney Disease

Christopher D Owens et al. J Vasc Access.

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.

Conflict of interest statement

Competition of Interest: None

Figures

Fig. 1
Fig. 1
A significant increase arterial and venous lumen diameter was observed over the first 3 months of AVF creation. Despite a mean increase in luminal enlargement, there is considerable heterogeneity of remodeling, [(3-month diameter-baseline diameter) ÷ baseline diameter] X 100, in the first 3 months.
Fig. 2
Fig. 2
There is a positive correlation between the magnitude of arterial and venous remodeling in the maturing AVF.
Fig. 3
Fig. 3
Endothelium-dependent, flow mediated, brachial artery dilation was 5.82% ± .9%, indicating severe impairment of endothelial function in this population.
Fig. 4
Fig. 4
There is a significant positive correlation between brachial artery flow mediated dilation and final venous luminal dimension.

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