Abstract：
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
背景：血液透析是全球晚期慢性肾脏病（CKD）的普遍治疗方法。原发性动静脉瘘（AVF），被广泛认为是最佳的血液透析接入方法，在多达三分之二的案件中未能成熟。早期AVF衰竭的病因，定义为血栓形成或无法在创建后三个月内使用，受到各种因素的影响，包括患者的人口统计学，外科技术,和遗传倾向。新生内膜增生是导致AVF衰竭的狭窄病变的主要组织学发现。然而,关于细胞表型和先前存在的CKD相关因素的影响的数据不足.本研究旨在探讨组织学,形态计量学,瘘管静脉的免疫组织化学改变，pre,pery-,早期失败后。
方法：89例4-5期CKD患者接受标准术前评估，包括多普勒超声,在典型的射头AVF创建之前。失败后,在近端创建了一个新的AVF。手术期间采集静脉标本,已处理,并分析形态分析和各种细胞标记，包括Vimentin,TGF,Ki67
结果：该研究招募了89名CKD患者，分析其状况和AVF故障的各个方面。组织形态计量学分析显示静脉腔严重狭窄和内皮变化。免疫组织学分析显示了AVF产生前后的差异标记表达。
结论：本研究强调了CKD患者早期AVF衰竭的复杂性。内侧肥大表现为明显的预先存在的病变，而术后分析表明向新内膜增生转变。这项研究强调了血管重塑的微妙相互作用，内皮损伤，和AVF结果中的细胞增殖。
方法：89例4-5期CKD患者接受标准术前评估，包括多普勒超声,在典型的射头AVF创建之前。失败后,在近端创建了一个新的AVF。手术期间采集静脉标本,已处理,并分析形态分析和各种细胞标记，包括Vimentin,TGF,Ki67
结果：该研究招募了89名CKD患者，分析其状况和AVF故障的各个方面。组织形态计量学分析显示静脉腔严重狭窄和内皮变化。免疫组织学分析显示了AVF产生前后的差异标记表达。
结论：本研究强调了CKD患者早期AVF衰竭的复杂性。内侧肥大表现为明显的预先存在的病变，而术后分析表明向新内膜增生转变。这项研究强调了血管重塑的微妙相互作用，内皮损伤，和AVF结果中的细胞增殖。
