TY - JOUR
T1 - Pre-existing and Postoperative Intimal Hyperplasia and Arteriovenous Fistula Outcomes
AU - Tabbara, Marwan
AU - Duque, Juan C.
AU - Martinez, Laisel
AU - Escobar, Luis A.
AU - Wu, Wensong
AU - Pan, Yue
AU - Fernandez, Natasha
AU - Velazquez, Omaida C.
AU - Jaimes, Edgar A.
AU - Salman, Loay H.
AU - Vazquez-Padron, Roberto I.
N1 - Funding Information:
Support: The National Institutes of Health (NIH) grant R01-DK-098511 to Drs Vazquez-Padron and Salman supported this study. The NIH had no role in the study design; collection, analysis, and interpretation of data; writing the report; and the decision to submit the report for publication.
Publisher Copyright:
© 2016 National Kidney Foundation, Inc.
PY - 2016/9/1
Y1 - 2016/9/1
N2 - Background The contribution of intimal hyperplasia (IH) to arteriovenous fistula (AVF) failure is uncertain. This observational study assessed the relationship between pre-existing, postoperative, and change in IH over time and AVF outcomes. Study Design Prospective cohort study with longitudinal assessment of IH at the time of AVF creation (pre-existing) and transposition (postoperative). Patients were followed up for up to 3.3 years. Setting & Participants 96 patients from a single center who underwent AVF surgery initially planned as a 2-stage procedure. Veins and AVF samples were collected from 66 and 86 patients, respectively. Matched-pair tissues were available from 56 of these patients. Predictors Pre-existing, postoperative, and change in IH over time. Outcomes Anatomic maturation failure was defined as an AVF that never reached a diameter > 6 mm. Primary unassisted patency was defined as the time elapsed from the second-stage surgery to the first intervention. Measurements Maximal intimal thickness in veins and AVFs and change in intimal thickness over time. Results Pre-existing IH (>0.05 mm) was present in 98% of patients. In this group, the median intimal thickness increased 4.40-fold (IQR, 2.17- to 4.94-fold) between AVF creation and transposition. However, this change was not associated with pre-existing thickness (r2 = 0.002; P = 0.7). Ten of 96 (10%) AVFs never achieved maturation, whereas 70% of vascular accesses remained patent at the end of the observational period. Postoperative IH was not associated with anatomic maturation failure using univariate logistic regression. Pre-existing, postoperative, and change in IH over time had no effects on primary unassisted patency. Limitations The small number of patients from whom longitudinal tissue samples were available and low incidence of anatomic maturation failure, which decreased the statistical power to find associations between end points and IH. Conclusions Pre-existing, postoperative, and change in IH over time were not associated with 2-stage AVF outcomes.
AB - Background The contribution of intimal hyperplasia (IH) to arteriovenous fistula (AVF) failure is uncertain. This observational study assessed the relationship between pre-existing, postoperative, and change in IH over time and AVF outcomes. Study Design Prospective cohort study with longitudinal assessment of IH at the time of AVF creation (pre-existing) and transposition (postoperative). Patients were followed up for up to 3.3 years. Setting & Participants 96 patients from a single center who underwent AVF surgery initially planned as a 2-stage procedure. Veins and AVF samples were collected from 66 and 86 patients, respectively. Matched-pair tissues were available from 56 of these patients. Predictors Pre-existing, postoperative, and change in IH over time. Outcomes Anatomic maturation failure was defined as an AVF that never reached a diameter > 6 mm. Primary unassisted patency was defined as the time elapsed from the second-stage surgery to the first intervention. Measurements Maximal intimal thickness in veins and AVFs and change in intimal thickness over time. Results Pre-existing IH (>0.05 mm) was present in 98% of patients. In this group, the median intimal thickness increased 4.40-fold (IQR, 2.17- to 4.94-fold) between AVF creation and transposition. However, this change was not associated with pre-existing thickness (r2 = 0.002; P = 0.7). Ten of 96 (10%) AVFs never achieved maturation, whereas 70% of vascular accesses remained patent at the end of the observational period. Postoperative IH was not associated with anatomic maturation failure using univariate logistic regression. Pre-existing, postoperative, and change in IH over time had no effects on primary unassisted patency. Limitations The small number of patients from whom longitudinal tissue samples were available and low incidence of anatomic maturation failure, which decreased the statistical power to find associations between end points and IH. Conclusions Pre-existing, postoperative, and change in IH over time were not associated with 2-stage AVF outcomes.
KW - AVF creation
KW - AVF transposition
KW - Intimal hyperplasia (IH)
KW - anatomic maturation failure
KW - arteriovenous fistula (AVF)
KW - end-stage renal disease (ESRD)
KW - failure
KW - hemodialysis
KW - histology
KW - intimal thickness
KW - outcomes
KW - primary unassisted patency
KW - stenosis
KW - vascular access
KW - vascular pathology
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U2 - 10.1053/j.ajkd.2016.02.044
DO - 10.1053/j.ajkd.2016.02.044
M3 - Article
C2 - 27012909
AN - SCOPUS:84962144616
VL - 68
SP - 455
EP - 464
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
SN - 0272-6386
IS - 3
ER -