AI Article Synopsis
- The study aimed to evaluate how the vascularization of venous walls relates to the occurrence of neointimal hyperplasia (NIH) in failed arteriovenous fistulae (AVFs).
- A total of 43 patients with new AVF creation and 39 with failed fistula reconstructions were analyzed through histopathological methods, highlighting significant differences in vascular density.
- The results showed that failed AVFs had notably thicker intimal layers and higher vascular density compared to preaccess veins, indicating a correlation between vascularization and NIH, along with increased expression of vascular endothelial growth factor A in failed AVFs.
Article Abstract
Purpose: To assess venous wall vascularization and its correlation with neointimal hyperplasia (NIH) in failed arteriovenous fistulae (AVFs).
Materials And Methods: A total of 43 uremic patients who underwent de novo AVF creation and 39 patients who underwent reconstruction of failed fistulae were enrolled in the study. A 5-10-mm vein segment adjacent to the future fistula creation or reconstruction site was surgically removed and assessed using histopathological analyses and stained by immunohistochemistry to quantify vasa vasorum density (VVD).
Results: Both the intimal thickness (70.68 [28.81-99.54] vs 4.53 [2.69-7.30] μm, P < .001) and the intimal thickness-to-medial thickness ratio (2.20 [0.77-4.36] vs 0.15 [0.10-0.30], P < .001) were higher in failed AVFs than in preaccess veins. CD31- and factor VIII-marked VVDs in both the intima (6.31 [1.62-12.53] vs 0.0 [0.0-0.0], P < .001; 7.82 [3.33-11.61] vs 0.0 [0.0-0.0], P < .001) and media (10.0 [7.59-12.95] vs 3.71 [2.44-4.87], P < .001; 8.33 [5.55-13.0] vs 3.57 [2.53-4.82], P < .001) as well as the intimal VVD:medial VVD ratio (0.67 [0.19-1.08] vs 0.0 [0.0-0.0], P < .001; 0.71 [0.39-1.14] vs 0.0 [0.0-0.0], P < .001) were significantly higher in failed AVFs than in preaccess veins. Moreover, there was a positive relationship between the intimal VVD:medial VVD ratio and the intimal thickness:medial thickness ratio (P < .001). In addition, the vascular endothelial cell growth factor A expression was higher in failed AVFs than in preaccess veins.
Conclusions: Vascularization of the vessel wall was noticeably more developed in the arterialized veins, especially at the NIH regions in failed AVFs.
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| http://dx.doi.org/10.1016/j.jvir.2022.05.004 | DOI Listing |
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