Dimethylarginine Dimethylaminohydrolase 1 Polymorphisms and Venous Intimal Hyperplasia in Hemodialysis Patients

2019 ◽  
Vol 50 (6) ◽  
pp. 454-464 ◽  
Author(s):  
Chih-Cheng Wu ◽  
Mu-Yang Hsieh ◽  
Chih-Kuo Lee ◽  
Shao-Yuan Chuang ◽  
Ming-Yi Chung ◽  
...  
Keyword(s):  
Vascular Access ◽  
Intimal Hyperplasia ◽  
Nucleotide Polymorphisms ◽  
Dimethylarginine Dimethylaminohydrolase ◽  
Arteriovenous Fistulas ◽  
Plasma Adma ◽  
Observational Cohort ◽  
Arteriovenous Grafts ◽  
Early Restenosis

Background: After angioplasty, veins are more prone to intimal hyperplasia than arteries. Veins tend to produce less nitric oxide (NO), which could lead to endothelial dysfunction. Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of NO synthase and contributes to cardiovascular disease. In humans, dimethylarginine dimethylaminohydrolase 1 (DDAH1) is the major enzyme for ADMA degradation. In this study, we aim to determine whether venous intimal hyperplasia in hemodialysis (HD) vascular access is influenced by common polymorphisms in the DDAH1 genes. Methods: This is a prospective observational cohort study. A total of 473 HD patients referred for the angioplasty of vascular access were enrolled. There were 190 arteriovenous grafts (AVG) and 283 arteriovenous fistulas (AVF). The follow-up lasted for 2 years after the interventions. Seven single nucleotide polymorphisms (SNPs) in DDAH1 were genotyped and ADMA were measured at baseline. The primary outcome was restenosis after angioplasty. Results: Among the 7 SNPs, plasma ADMA levels were significantly different in DDAH1 rs233112 (GA + GG vs. AA, 0.86 ± 0.23 vs. 0.82 ± 0.19 μM, p = 0.03) and rs1498373 (CT + TT vs. CC, 0.87 ± 0.23 vs. 0.82 ± 0.20 μM, p = 0.02) genotypes. The AVF group with GG + GA genotype of rs233112 and CT + TT genotype of rs1498373 had higher risks of early restenosis at 3 months. In the AVG group, only GG + GA genotype of rs233112 was associated with early restenosis. A combined analysis of AVG and AVF groups showed that patients with rs233112 GA + GG genotype and rs1498373 CT + TT genotype had higher risks of early restenosis (both p < 0.001). The multivariate analysis results showed that the association of these genotypes with early restenosis is independent of clinical, access, or biochemical factors. Conclusions: Our findings suggest that certain DDAH1 polymorphisms modulate circulating ADMA levels and are associated with venous intimal hyperplasia.

scholarly journals Arteriovenous conduits for hemodialysis: how to better modulate the pathophysiological vascular response to optimize vascular access durability

2019 ◽  
Vol 316 (5) ◽  
pp. F794-F806 ◽  
Author(s):  
Yan-Ting Shiu ◽  
Joris I. Rotmans ◽  
Wouter Jan Geelhoed ◽  
Daniel B. Pike ◽  
Timmy Lee
Keyword(s):  
Vascular Access ◽  
Intimal Hyperplasia ◽  
Vascular Remodeling ◽  
Clinical Problem ◽  
Future Research ◽  
Vascular Response ◽  
Arteriovenous Fistulas ◽  
Venous Stenosis ◽  
Arteriovenous Grafts ◽  
Clinical Problems

Vascular access is the lifeline for patients on hemodialysis. Arteriovenous fistulas (AVFs) are the preferred vascular access, but AVF maturation failure remains a significant clinical problem. Currently, there are no effective therapies available to prevent or treat AVF maturation failure. AVF maturation failure frequently results from venous stenosis at the AVF anastomosis, which is secondary to poor outward vascular remodeling and excessive venous intimal hyperplasia that narrows the AVF lumen. Arteriovenous grafts (AVGs) are the next preferred vascular access when an AVF creation is not possible. AVG failure is primarily the result of venous stenosis at the vein-graft anastomosis, which originates from intimal hyperplasia development. Although there has been advancement in our knowledge of the pathophysiology of AVF maturation and AVG failure, this has not translated into effective therapies for these two important clinical problems. Further work will be required to dissect out the mechanisms of AVF maturation failure and AVG failure to develop more specific therapies. This review highlights the major recent advancements in AVF and AVG biology, reviews major clinical trials, and discusses new areas for future research.

scholarly journals Does Regular Surveillance Improve the Long-Term Survival of Arteriovenous Fistulas?

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Ashwin Shetty ◽  
William L. Whittier
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Major Complication ◽  
Limited Data ◽  
Term Survival ◽  
Long Term Survival ◽  
Arteriovenous Fistulas ◽  
Arteriovenous Grafts ◽  
Available Information

The rate of arteriovenous fistula (AVF) placement continues to rise and AVF failure is a major complication. The main cause of AVF failure is stenosis leading to thrombosis. Although the detection of early stenosis with preemptive correction prior to thrombosis seems to be a plausible option to prevent access failure, there is much debate, on the basis of studies of surveillance with arteriovenous grafts, as to whether early surveillance actually improves the longevity of AVFs. Evaluating the available information for surveillance, specifically the data for AVF stenosis and survival, is necessary to determine if surveillance is warranted. These trials have shown that vascular access flow (Qa) surveillance is beneficial in revealing subclinical stenosis. Preemptive angioplasty and surgical revision have shown to decrease thrombosis rates. However, at the present time, there is only limited data on whether preemptive treatment equates to improved long-term AVF survival.

Single-centre experience of an early cannulation graft for haemodialysis access

2020 ◽  
Vol 21 (6) ◽  
pp. 883-891
Author(s):  
Rupesh Sutaria ◽  
James A Gilbert
Keyword(s):  
Vascular Access ◽  
Complication Rate ◽  
Secondary Patency ◽  
Dialysis Access ◽  
Population Changes ◽  
Single Centre ◽  
Single Centre Experience ◽  
Arteriovenous Grafts

Introduction: As the demographics of the population changes, increasing challenges are being faced in providing reliable access for dialysis. This article reports on the outcomes from the largest series to date using the early cannulation graft Flixene in a single centre. Methods: Between May 2012 and March 2018, 141 Flixene grafts were placed for dialysis access. The outcomes of the arteriovenous grafts were reviewed retrospectively from electronically held records and imaging. Results: In 75 patients, placement of Flixene graft was performed on an emergency basis and in 66 patients on a planned elective list. The 12-month primary, assisted primary and secondary patency rates were 48.7%, 56.6% and 83.6%, respectively. Eight (5.7%) patients developed infections of the graft during the follow-up period. Conclusion: In our experience, we have found the use of the early cannulation graft Flixene to be safe with a low complication rate and favourable patency rates. We believe these early cannulation grafts provide a useful addition for vascular access surgeons preventing the use of tunnelled lines and providing more flexibility in the timing of placing a graft for dialysis.

scholarly journals Surgical intervention for upper extremity nerve compression related to arteriovenous hemodialysis accesses

2020 ◽  
pp. 112972982092271
Author(s):  
Jan HM Tordoir ◽  
Magda M van Loon ◽  
Niek Zonnebeld ◽  
Maarten Snoeijs ◽  
Ferry van Nie
Keyword(s):  
Median Nerve ◽  
Vascular Access ◽  
Surgical Intervention ◽  
Nerve Compression ◽  
Motor Deficits ◽  
Vascular Access Surgery ◽  
Arteriovenous Fistulas ◽  
Arteriovenous Grafts ◽  
Access Surgery ◽  
Nerve Release

Objective: Chronic renal failure patients with arteriovenous hemodialysis access may exhibit pain and neurological complaints due to local nerve compression by the access conduit vessels of autogenous arteriovenous fistulas or the prosthesis of arteriovenous grafts. In this study, we have examined the results of surgical intervention for vascular access–related nerve compression in the upper extremity. Methods: A single center retrospective study was performed of all patients referred for persistent pain and neurological complaints after vascular access surgery for hemodialysis. There were four brachial-cephalic, three brachial-basilic upper arm arteriovenous fistulas, and three prosthetic arteriovenous grafts. All patients had pain and sensory deficits in a distinct nerve territory (median nerve: 6; median + ulnar nerve: 1; medial cutaneous nerve: 1), and two patients had additional motor deficits (median nerve). Results: A total of 10 patients (mean age: 59 years; range: 25–73 years; 2 men; 4 diabetics) were treated by surgical nerve release alone (2 patients) or in combination with access revision (8 patients). Mean follow-up was 23 months (range: 8–46 months). Direct complete relief of symptoms was achieved in six patients. Three patients had minor complaints, and one patient had a reoperation with good success. Conclusion: Vascular access–related nerve compression is an uncommon cause for pain, sensory and motor deficits after vascular access surgery. Surgical nerve release and access revision have good clinical outcome with relief of symptoms and maintenance of the access site in the majority of patients.

Impact of arteriovenous fistulas versus arteriovenous grafts on vascular access performance in haemodialysis patients: A systematic review and meta-analysis

Vascular ◽  
2021 ◽  
pp. 170853812110414
Author(s):  
Shahin Hajibandeh ◽  
Hannah Burton ◽  
Philippa Gleed ◽  
Shahab Hajibandeh ◽  
Teun Wilmink
Keyword(s):  
Failure Rate ◽  
Vascular Access ◽  
Meta Analysis ◽  
Primary Patency ◽  
Free Access ◽  
Secondary Patency ◽  
Confounding By Indication ◽  
Arteriovenous Fistulas ◽  
Significant Difference ◽  
Arteriovenous Grafts

Background Controversy exists regarding the best-performing vascular access type for patients undergoing haemodialysis. We aimed to compare outcomes of starting dialysis on arteriovenous fistulas (AVFs) versus arteriovenous grafts (AVGs) in haemodialysis patients. Methods We conducted a systematic search of multiple electronic information sources and bibliographic reference lists. The following outcome parameters were evaluated at 1, 2 and 5 years: primary failure, defined as access never used for dialysis; primary patency, defined as intervention-free access survival; primary-assisted patency, defined as uninterrupted access survival with interventions; and secondary patency, defined as cumulative access survival. Results We identified 15 comparative studies reporting a total of 118,434 patients who initiated haemodialysis with AVF ( n = 95,143) or AVG ( n = 23,291). Our analysis demonstrated that AVF was associated with significantly higher primary failure rate (OR: 2.05, p = .0005) but significantly higher rate of primary patency at 1 year (OR: 1.91, p < .00001), at 2 years (OR: 2.52, p < .00001) and at 5 years (OR: 2.59, p < .00001); and primary-assisted patency at 1 year (OR: 1.71, p < .00001), at 2 years (OR: 2.13, p < .00001) and 5 years (OR: 2.79, p < .00001). There was no significant difference in secondary patency at 1 year (OR: 1.08, p < .00001) but AVF had better secondary patency at 2 years (OR: 1.26, p < .00001) and 5 years (OR: 1.60, p < .00001) than AVG. Conclusions The meta-analysis of best available comparative evidence (Level 2) demonstrated that AVFs may be associated with significantly higher primary failure rate but higher primary patency, primary-assisted patency and secondary patency at 1, 2 and 5 years compared to AVGs. However, the available evidence is subject to significant selection bias and confounding by indication.

scholarly journals Cost-effectiveness of Vascular Access for Haemodialysis: Arteriovenous Fistulas Versus Arteriovenous Grafts

2013 ◽  
Vol 57 (1) ◽  
pp. 286 ◽  
Author(s):  
J.J.P.M. Leermakers ◽  
A.S. Bode ◽  
A. Vaidya ◽  
F.M. van der Sande ◽  
S.M.A.A. Evers ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Vascular Access ◽  
Arteriovenous Fistulas ◽  
Arteriovenous Grafts
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