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    Endothelial function predicts positive arterial-venous fistula remodeling in subjects with stage IV and V chronic kidney disease

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    Authors
    Owens, Christopher D.
    Wake, Nicole
    Kim, Ji Min
    Hentschel, Dirk
    Conte, Michael S.
    Schanzer, Andres
    UMass Chan Affiliations
    Department of Surgery
    Document Type
    Journal Article
    Publication Date
    2010-11-03
    Keywords
    Arteriovenous Shunt, Surgical
    Brachial Artery
    Brachiocephalic Veins
    Endothelium, Vascular
    Kidney Diseases
    Renal Dialysis
    Surgery
    
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    Link to Full Text
    http://www.vascular-access.info/public/JVA/Issue/Navigator.action?cmd=navigate&urlkey=Abstract&UidArticle=BE10445A-8084-4034-B3ED-81D55C5C06C4&t=JVA
    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.
    Source
    J Vasc Access. 2010 Oct-Dec;11(4):329-34.
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/49761
    PubMed ID
    21038305
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