Department of Internal Medicine, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands.
Department of Surgery and the Heart and Vascular Center, Brigham & Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
Int J Mol Sci. 2023 Jun 28;24(13):10825. doi: 10.3390/ijms241310825.
Vascular access is the lifeline for patients receiving haemodialysis as kidney replacement therapy. As a surgically created arteriovenous fistula (AVF) provides a high-flow conduit suitable for cannulation, it remains the vascular access of choice. In order to use an AVF successfully, the luminal diameter and the vessel wall of the venous outflow tract have to increase. This process is referred to as AVF maturation. AVF non-maturation is an important limitation of AVFs that contributes to their poor primary patency rates. To date, there is no clear overview of the overall role of the extracellular matrix (ECM) in AVF maturation. The ECM is essential for vascular functioning, as it provides structural and mechanical strength and communicates with vascular cells to regulate their differentiation and proliferation. Thus, the ECM is involved in multiple processes that regulate AVF maturation, and it is essential to study its anatomy and vascular response to AVF surgery to define therapeutic targets to improve AVF maturation. In this review, we discuss the composition of both the arterial and venous ECM and its incorporation in the three vessel layers: the tunica intima, media, and adventitia. Furthermore, we examine the effect of chronic kidney failure on the vasculature, the timing of ECM remodelling post-AVF surgery, and current ECM interventions to improve AVF maturation. Lastly, the suitability of ECM interventions as a therapeutic target for AVF maturation will be discussed.
血管通路是接受血液透析作为肾脏替代治疗的患者的生命线。由于手术创建的动静脉瘘（AVF）提供了适合插管的高流量导管，因此它仍然是首选的血管通路。为了成功使用 AVF，静脉流出道的管腔直径和血管壁必须增加。这个过程被称为 AVF 成熟。AVF 不成熟是 AVF 的一个重要限制因素，导致其初次通畅率较差。迄今为止，对于细胞外基质（ECM）在 AVF 成熟中的整体作用还没有明确的概述。ECM 对血管功能至关重要，因为它提供结构和机械强度，并与血管细胞进行通讯，以调节其分化和增殖。因此，ECM 参与调节 AVF 成熟的多个过程，研究其解剖结构和对 AVF 手术的血管反应对于确定改善 AVF 成熟的治疗靶点至关重要。在这篇综述中，我们讨论了动脉和静脉 ECM 的组成及其在三个血管层中的整合：内膜、中膜和外膜。此外，我们还研究了慢性肾衰竭对血管的影响、AVF 手术后 ECM 重塑的时间以及改善 AVF 成熟的当前 ECM 干预措施。最后，将讨论 ECM 干预作为 AVF 成熟治疗靶点的适宜性。
