DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida.
Katz Family Division of Nephrology, Department of Medicine, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida.
Kidney360. 2021 Aug;2(8):1360-1372. doi: 10.34067/KID.0002022021.
The development of venous intimal hyperplasia (IH) has been historically associated with failure of arteriovenous fistulas (AVF) used for hemodialysis. This long-standing assumption, based on histological observations, has been recently challenged by clinical studies indicating that the size of the intima by itself is not enough to explain stenosis or AVF maturation failure. Irrespective of this lack of association, IH is present in most native veins and fistulas, is prominent in many cases, and suggests a role in the vein that may not be reflected by its dimensions. Therefore, the contribution of IH to AVF dysfunction remains controversial. Using only clinical data and avoiding extrapolations from animal models, we critically discuss the biological significance of IH in vein remodeling, vascular access function, and the response of the venous wall to repeated trauma in hemodialysis patients. We address questions and pose new ones such as: What are the factors that contribute to IH in pre-access veins and AVFs? Do cellular phenotypes and composition of the intima influence AVF function? Are there protective roles of the venous intima? This review explores these possibilities, with hopes of rekindling a critical discussion about venous IH that goes beyond thickness and AVF outcomes.
静脉内膜增生（IH）的发展一直与用于血液透析的动静脉瘘（AVF）失败有关。这种基于组织学观察的长期假设最近受到了临床研究的挑战，这些研究表明内膜本身的大小不足以解释狭窄或 AVF 成熟失败。尽管缺乏这种关联，但 IH 存在于大多数天然静脉和瘘管中，在许多情况下很明显，并表明其在静脉中的作用可能与其尺寸无关。因此，IH 对 AVF 功能的影响仍然存在争议。我们仅使用临床数据，避免从动物模型中推断，批判性地讨论 IH 在静脉重塑、血管通路功能以及血液透析患者静脉壁对反复创伤的反应中的生物学意义。我们探讨了一些问题并提出了一些新的问题，例如：是什么因素导致了预通路静脉和 AVF 中的 IH？内膜的细胞表型和组成是否会影响 AVF 功能？静脉内膜是否有保护作用？本综述探讨了这些可能性，希望重新引发关于静脉 IH 的批判性讨论，超越厚度和 AVF 结果。
