Lee Timmy, Ul Haq Naveed
Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Birmingham Veterans Affairs Medical Center, Birmingham, AL; Section of Nephrology, Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudia Arabia.
Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; Birmingham Veterans Affairs Medical Center, Birmingham, AL; Section of Nephrology, Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudia Arabia.
Adv Chronic Kidney Dis. 2015 Nov;22(6):431-7. doi: 10.1053/j.ackd.2015.06.010.
The vascular access remains the lifeline for the hemodialysis patient. The most common etiology of vascular access dysfunction is venous stenosis at the vein-artery anastomosis in arteriovenous fistula and at the vein-graft anastomosis in arteriovenous grafts (AVG). This stenotic lesion is typically characterized on histology as aggressive venous neointimal hyperplasia in both arteriovenous fistula and AVG. In recent years, we have advanced our knowledge and understanding of neointimal hyperplasia in vascular access and begun testing several novel therapies. This article will (1) review recent developments in our understanding of the pathophysiology of neointimal hyperplasia development in AVG and fistula failure, (2) discuss atypical factors leading to neointimal hyperplasia development, (3) highlight key novel therapies that have been evaluated in clinical trials, and (4) discuss future opportunities and challenges to improve our understanding of vascular access dysfunction and translate this knowledge into novel and innovative therapies.
血管通路仍然是血液透析患者的生命线。血管通路功能障碍最常见的病因是动静脉内瘘中静脉 - 动脉吻合口处以及动静脉移植物（AVG）中静脉 - 移植物吻合口处的静脉狭窄。这种狭窄病变在组织学上的典型特征是动静脉内瘘和AVG中均出现侵袭性静脉内膜增生。近年来，我们对血管通路中内膜增生的认识和理解有所进步，并开始测试几种新型疗法。本文将：（1）回顾我们对AVG内膜增生发展的病理生理学以及内瘘失败的最新认识进展；（2）讨论导致内膜增生发展的非典型因素；（3）强调在临床试验中已评估的关键新型疗法；（4）讨论未来的机遇和挑战，以增进我们对血管通路功能障碍的理解，并将这一知识转化为新颖和创新的疗法。
