Circulation, Vol 80, 1726-1736, Copyright © 1989 by American Heart Association
SH Swedberg, BG Brown, R Sigley, TN Wight, D Gordon and SC Nicholls
Failure of arteriovenous communications used for chronic hemodialysis was
studied during sequential 5-year periods after placement of either
endogenous Brescia-Cimino (B-C) fistulas (50 patients) or
polytetrafluoroethylene (PTFE, Gore-Tex) grafts (66 patients). Venous
stenosis near the anastomosis was the reason for failure in 45% of PTFE
grafts compared with 16% of B-C fistulas (p less than 0.001). Failure
occurred, on average, 16 months after PTFE graft placement compared with 22
for B-C fistulas (p = NS). Proximal vein segments removed from five failed
and two functioning PTFE graft communications were studied using light and
electron microscopy and immunocytochemical techniques. All venous segments
removed during surgical shunt repair exhibited a marked intimal
hyperplasia. The intimal cellular component was almost exclusively smooth
muscle. Accumulation of intracellular lipid droplets was not seen. Foam
cells as well as extracellular lipid deposits were absent; macrophages and
lymphocytes were absent from the zone of proliferation. Ultrastructural
examination revealed a large proportion of extracellular matrix surrounding
smooth muscle cells in the neointima. Collagen and elastin were present in
the extracellular matrix, in greatest concentration deeper in the intima.
Closer to the lumen, most of the extracellular volume consisted of
proteoglycan. Hemosiderin was absent from the lesions as were consistent
signs of luminal and intimal fibrin. Uniform intimal gradients of actin,
collagen, and proteoglycan suggest that this is a steadily progressive,
rather than episodic, proliferative response. These clinical and histologic
observations and an analysis of hemodynamic stresses support the postulate
that upstream release of platelet-derived growth factor, and possibly,
shear-induced intimal injury stimulate this response. This myointimal
proliferative process provides a readily accessible model of fibromuscular
hyperplasia in humans; its understanding may lead to effective methods for
its prevention and may provide clues to the pathogenesis of
arteriosclerosis.
ARTICLES
Intimal fibromuscular hyperplasia at the venous anastomosis of PTFE grafts in hemodialysis patients. Clinical, immunocytochemical, light and electron microscopic assessment
Department of Medicine, University of Washington School of Medicine, Seattle.
This article has been cited by other articles:
 |
|
 |
|
  A. R. Forauer, E. K. Hoffer, and K. Homa Dialysis Access Venous Stenoses: Treatment with Balloon Angioplasty--1- versus 3-minute Inflation Times1 Radiology, October 1, 2008; 249(1): 375 - 381. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. R. Chan, S. Bedi, R. J. Sanchez, H. N. Young, Y. T. Becker, P. S. Kellerman, and A. S. Yevzlin Stent Placement Versus Angioplasty Improves Patency of Arteriovenous Grafts and Blood Flow of Arteriovenous Fistulae Clin. J. Am. Soc. Nephrol., May 1, 2008; 3(3): 699 - 705. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. E. Lok, M. Allon, S. Donnelly, M. Dorval, B. Hemmelgarn, L. Moist, M. J. Oliver, M. Tonelli, and K. Stanley Design of the fish oil inhibition of stenosis in hemodialysis grafts (FISH) study Clinical Trials, August 1, 2007; 4(4): 357 - 367. [Abstract] [PDF]
|
|
|
|
 |
|
 A. Sajgure, A. Choudhury, Z. Ahmed, and D. Choudhury Angiotensin converting enzyme inhibitors maintain polytetrafluroethylene graft patency Nephrol. Dial. Transplant., May 1, 2007; 22(5): 1390 - 1398. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Roy-Chaudhury, V. P. Sukhatme, and A. K. Cheung Hemodialysis Vascular Access Dysfunction: A Cellular and Molecular Viewpoint J. Am. Soc. Nephrol., April 1, 2006; 17(4): 1112 - 1127. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. D. Levit, R. M. Cohen, A. Kwak, R. D. Shlansky-Goldberg, T. W. I. Clark, A. A. Patel, S. W. Stavropoulos, J. I. Mondschein, J. A. Solomon, C. M. Tuite, et al. Asymptomatic Central Venous Stenosis in Hemodialysis Patients Radiology, March 1, 2006; 238(3): 1051 - 1056. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. S Dixon, G. J Beck, L. M Dember, T. A Depner, J. J Gassman, T. Greene, J. Himmelfar, L. G Hunsicker, J. S Kaufman, J. H Lawson, et al. Design of the Dialysis Access Consortium (DAC) Aggrenox prevention of access stenosis trial Clinical Trials, October 1, 2005; 2(5): 400 - 412. [Abstract] [PDF]
|
|
|
|
 |
|
 Z. Luo, G. Y. Akita, T. Date, C. Treleaven, K. A. Vincent, D. Woodcock, S. H. Cheng, R. J. Gregory, and C. Jiang Adenovirus-Mediated Expression of {beta}-Adrenergic Receptor Kinase C-Terminus Reduces Intimal Hyperplasia and Luminal Stenosis of Arteriovenous Polytetrafluoroethylene Grafts in Pigs Circulation, April 5, 2005; 111(13): 1679 - 1684. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. A. Nath, S. K. R. Kanakiriya, J. P. Grande, A. J. Croatt, and Z. S. Katusic Increased Venous Proinflammatory Gene Expression and Intimal Hyperplasia in an Aorto-Caval Fistula Model in the Rat Am. J. Pathol., June 1, 2003; 162(6): 2079 - 2090. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Wallace, J. W. Thomas, K. Ahrar, and K. C. Wright Transrenal Arteriovenous Dialysis Graft Creation: Survival and Patency in a Swine Model Radiology, May 1, 2003; 227(2): 501 - 509. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. Z. Erzurum, U. O. Hafeli, M. K. Hirko, S. P. Schmidt, and J. R. Rubin Local Application of Beta-Particle Radiation to Reduce Venous Anastomotic Intimal Hyperplasia in Polytetrafluoroethylene Arteriovenous Fistulas Vascular and Endovascular Surgery, September 1, 2000; 34(5): 377 - 383. [Abstract] [PDF]
|
|
|
|
|
|
N. IKEGAYA, T. YAMAMOTO, A. TAKESHITA, T. WATANABE, K. YONEMURA, T. MIYAJI, K. OHISHI, M. FURUHASHI, Y. MARUYAMA, and A. HISHIDA Elevated Erythropoietin Receptor and Transforming Growth Factor-{beta}1 Expression in Stenotic Arteriovenous Fistulae Used for Hemodialysis J. Am. Soc. Nephrol., May 1, 2000; 11(5): 928 - 935. [Abstract] [Full Text]
|
|
|
|
|
|
S. O. Trerotola, T. J. Carmody, R. D. Timmerman, K. A. Bergan, R. G. Dreesen, S. V. Frost, and M. Forney Brachytherapy for the Prevention of Stenosis in a Canine Hemodialysis Graft Model: Preliminary Observations Radiology, September 1, 1999; 212(3): 748 - 754. [Abstract] [Full Text]
|
|
|
|
|
|
R. Brandl, T. Richter, K. Haug, M. G. Wilhelm, P. C. Maurer, and W. Nathrath Topographic Analysis of Proliferative Activity in Carotid Endarterectomy Specimens by Immunocytochemical Detection of the Cell Cycle–Related Antigen Ki-67 Circulation, November 18, 1997; 96(10): 3360 - 3368. [Abstract] [Full Text]
|
|
|
|
 |
|
 R. A. Hirth, M. N. Turenne, J. D. Woods, E. W. Young, F. K. Port, M. V. Pauly, and P. J. Held Predictors of Type of Vascular Access in Hemodialysis Patients JAMA, October 23, 1996; 276(16): 1303 - 1308. [Abstract] [PDF]
|
|
|
|
|
|
C. Chen, S. G. Mattar, J. D. Hughes, G. F. Pierce, J. E. Cook, D. N. Ku, S. R. Hanson, and A. B. Lumsden Recombinant Mitotoxin Basic Fibroblast Growth Factor–Saporin Reduces Venous Anastomotic Intimal Hyperplasia in the Arteriovenous Graft Circulation, October 15, 1996; 94(8): 1989 - 1995. [Abstract] [Full Text]
|
|
|
|
 |
|
 Y. Erdem, I. C. Haznedaroglu, I. Celik, A. U. Yalcin, U. Yasavul, C. Turgan, S. Kirazli, and S. Caglar Coagulation and Fibrinolysis in Amyloid and Non-amyloid Hemodialysis Patients: Assessment of Local Hemostatic Kinetics Within Arteriovenous Fistulas Clinical and Applied Thrombosis/Hemostasis, October 1, 1996; 2(4): 279 - 284. [Abstract] [PDF]
|
|
|
|
|
|
L. Hofstra, J. H.M. Tordoir, P. J.E.H.M. Kitslaar, A. P.G. Hoeks, and M. J.A.P. Daemen Enhanced Cellular Proliferation in Intact Stenotic Lesions Derived From Human Arteriovenous Fistulas and Peripheral Bypass Grafts: Does It Correlate With Flow Parameters? Circulation, September 15, 1996; 94(6): 1283 - 1290. [Abstract] [Full Text]
|
|
|
|
|
|
V. Mickley, N. Rilinger, J. M. Friedrich, M. Storck, D. Abendroth, and L. Sunder-Plassmann Intraoperative Stent Implantation for Venous Anastomotic Stenoses of Hemodialysis Grafts Vascular and Endovascular Surgery, July 1, 1996; 30(4): 323 - 330. [Abstract] [PDF]
|
|