Maccarrone Rosario, Zanoli Luca, Pace Lillo, Di Stefano Giulio, Basile Antonio, Di Lullo Luca, Pesce Francesco, Fiorini Fulvio, Battaglia Giovanni Giorgio, Granata Antonio
UOC di Nefrologia e Dialisi, P.O. "San Giovanni di Dio", Agrigento, Italia.
Dip. di Medicina Interna, AOU "Policlinico - V. Emanuele" Università di Catania, Catania, Italia.
G Ital Nefrol. 2019 Apr;36(2).
Native arteriovenous fistula is the preferred vascular access because of it does not usually cause infections and seems to be closely related with prolonged patient survival, compared to prosthetic grafts and central venous catheters; it also is cost effective. Venous stenosis is one of the main causes of AVF failure. It is caused by a number of upstream and downstream events. The former group comprises hemodynamic and surgical stressors, inflammatory stimuli and uraemia, while downstream events involve the proliferation of smooth muscle cells and myofibroblasts and the development of neo-intimal hyperplasia. Percutaneous transluminal angioplasty is the gold standard for arteriovenous fistula stenosis. It allows the visualization of the whole vascular circuit and the immediate use of the vascular access for the next dialysis session. Ultrasound-guided percutaneous endovascular angioplasty is a feasible and safe alternative to conventional fluoroscopic technique: it is equally effective in treating arteriovenous fistula stenosis, but it presents the advantage of not using contrast media or ionizing radiation. The aim of this review is to report the latest evidence on cellular and molecular mechanisms that contribute to the development of neo-intimal hyperplasia, as well as the current and future therapeutic perspectives, especially concerning the use of anti-proliferative drugs, and the efficacy of the ultrasound-guided angioplasty in restoring and maintaining the vascular access patency over time.
自体动静脉内瘘是首选的血管通路，因为与人工血管移植物和中心静脉导管相比，它通常不会引起感染，而且似乎与患者的长期存活密切相关；它还具有成本效益。静脉狭窄是动静脉内瘘失功的主要原因之一。它由许多上游和下游事件引起。前者包括血流动力学和手术应激源、炎症刺激和尿毒症，而下游事件涉及平滑肌细胞和成肌纤维细胞的增殖以及新生内膜增生的发展。经皮腔内血管成形术是动静脉内瘘狭窄的金标准。它可以可视化整个血管回路，并可在下次透析治疗时立即使用该血管通路。超声引导下经皮血管腔内血管成形术是传统透视技术的一种可行且安全的替代方法：它在治疗动静脉内瘘狭窄方面同样有效，但具有不使用造影剂或电离辐射的优点。本综述的目的是报告有关导致新生内膜增生发展的细胞和分子机制的最新证据，以及当前和未来的治疗前景，特别是关于抗增殖药物的使用，以及超声引导下血管成形术在恢复和维持血管通路长期通畅方面的疗效。
