1University Clinic of Nephrology, Skopje, RN Macedonia.
2Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, RN Macedonia.
Pril (Makedon Akad Nauk Umet Odd Med Nauki). 2024 Jul 15;45(2):13-20. doi: 10.2478/prilozi-2024-0010. Print 2024 Jun 1.
Hemodialysis is a prevalent treatment for the end-stage chronic kidney disease (CKD) worldwide. The primary arteriovenous fistula (AVF), widely considered the optimal hemodialysis access method, fails to mature in up to two-thirds of the cases. The etiology of the early AVF failure, defined as thrombosis or inability to use within three months post-creation remains less understood, and is influenced by various factors including patient demographics, surgical techniques, and genetic predispositions. Neointimal hyperplasia is a primary histological finding in stenotic lesions leading to the AVF failure. However, there are insufficient data on the cellular phenotypes and the impact of the preexisting CKD-related factors. This study aims to investigate the histological, morphometric, and immunohistochemical alterations in the fistula vein, pre-, peri-, and post-early failure.
Eighty-nine stage 4-5 CKD patients underwent standard preoperative assessment, including the Doppler ultrasound, before a typical radio-cephalic AVF creation. Post-failure, a new AVF was created proximally. The vein specimens were collected during the surgery, processed, and analyzed for morphometric analyses and various cellular markers, including Vimentin, TGF, and Ki 67.
The study enrolled 89 CKD patients, analyzing various aspects of their condition and AVF failures. The histomorphometric analysis revealed substantial venous luminal stenosis and varied endothelial changes. The immunohistologic analysis showed differential marker expressions pre- and post-AVF creation.
This study highlights the complexity of the early AVF failures in CKD patients. The medial hypertrophy emerged as a significant preexisting lesion, while the postoperative analyses indicated a shift towards neointimal hyperplasia. The research underscores the nuanced interplay of vascular remodeling, endothelial damage, and cellular proliferation in the AVF outcomes.
血液透析是全球治疗终末期慢性肾脏病（CKD）的一种流行疗法。原发性动静脉瘘（AVF）被广泛认为是最佳的血液透析通路方法，但在多达三分之二的病例中无法成熟。早期 AVF 失败的病因（定义为血栓形成或在创建后三个月内无法使用）仍知之甚少，受多种因素影响，包括患者人口统计学、手术技术和遗传易感性。新生内膜增生是导致 AVF 失败的狭窄病变的主要组织学发现。然而，关于细胞表型以及与 CKD 相关的既有因素的影响，数据仍然不足。本研究旨在调查早期失败前、中、后瘘管静脉的组织学、形态计量和免疫组织化学改变。
89 名 4-5 期 CKD 患者在典型的桡尺侧 AVF 制作前进行标准术前评估，包括多普勒超声检查。失败后，在近端重新制作新的 AVF。手术中收集静脉标本，进行形态计量分析和各种细胞标志物（包括波形蛋白、TGF 和 Ki67）分析。
该研究纳入了 89 名 CKD 患者，分析了他们病情和 AVF 失败的各个方面。组织形态计量分析显示静脉腔明显狭窄和内皮变化多样。免疫组织化学分析显示 AVF 制作前后标志物表达存在差异。
本研究强调了 CKD 患者早期 AVF 失败的复杂性。中膜肥厚是一种重要的既有病变，而术后分析表明向新生内膜增生转变。该研究强调了血管重塑、内皮损伤和细胞增殖在 AVF 结局中的细微相互作用。
