期刊
INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES
卷 20, 期 21, 页码 -出版社
MDPI
DOI: 10.3390/ijms20215387
关键词
arteriovenous fistula; hypoxia; hypoxia-inducible factor; metabolism; neointimal hyperplasia
资金
- Fondation Flavien
- Fondation ARC
- La Ligue contre le Cancer
- Fondation de France
- Societe Francaise de Chirurgie Vasculaire et Endovasculaire
- NIH [R01HL128406, R01HL1444476]
For patients with end-stage renal disease requiring hemodialysis, their vascular access is both their lifeline and their Achilles heel. Despite being recommended as primary vascular access, the arteriovenous fistula (AVF) shows sub-optimal results, with about 50% of patients needing a revision during the year following creation. After the AVF is created, the venous wall must adapt to new environment. While hemodynamic changes are responsible for the adaptation of the extracellular matrix and activation of the endothelium, surgical dissection and mobilization of the vein disrupt the vasa vasorum, causing wall ischemia and oxidative stress. As a consequence, migration and proliferation of vascular cells participate in venous wall thickening by a mechanism of neointimal hyperplasia (NH). When aggressive, NH causes stenosis and AVF dysfunction. In this review we show how hypoxia, metabolism, and flow parameters are intricate mechanisms responsible for the development of NH and stenosis during AVF maturation.
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