Low-pressure environment and remodelling of the forearm vein in Brescia-Cimino haemodialysis access.

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Serval ID
serval:BIB_80A223635A58
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Low-pressure environment and remodelling of the forearm vein in Brescia-Cimino haemodialysis access.
Journal
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
Author(s)
Corpataux J.M., Haesler E., Silacci P., Ris H.B., Hayoz D.
ISSN
0931-0509
Publication state
Published
Issued date
2002
Peer-reviewed
Oui
Volume
17
Number
6
Pages
1057-62
Language
english
Notes
Publication types: Journal Article - Publication Status: ppublish
Abstract
BACKGROUND: The aim of the study was to determine which, and to what extent, haemodynamic parameters contribute to the remodelling of the venous limb of the Brescia-Cimino haemodialysis access. METHODS: The dimensions of the radial artery and the venous limb of the haemodialysis access were measured by an echo-tracking technique. In six ESRD patients undergoing primary arteriovenous fistula (AVF) formation, vessel diameter, wall thickness, blood pressure and blood flow were measured after the operation, and at 1 and 3 months follow-up. The contralateral forearm vessels in their native position served as baseline values for comparison. RESULTS: The diameter of the proximal antecubital vein progressively increased over the study period without reaching significant differences (4430, 5041 and 6620 microm at weeks 1, 4 and 12 respectively), whereas the intima-media thickness remained unchanged. The venous dilatation was associated with a reduction of the mean shear stress that culminated after the operation and progressively returned to normal venous values at 3 months (24.5 vs 10.4 dyne/cm(2), P<0.043). Thus the venous limb of the AVF undergoes eccentric hypertrophy as demonstrated by the increase in wall cross-sectional area (4.42 vs 6.32 mm(2) at week 1 vs week 12, P<0.028). At the time of the operation, the blood pressure in the AVF was 151+/-14/92.4+/-11 mmHg vs 49+/-19/24.5+/-6 mmHg (means+/-SEM) for the radial artery and the venous limb of the vascular access, respectively. One year after the operation the blood pressure in the venous limb had not changed: 42+/-14/25.3+/-7 mmHg (means+/-SEM). Under these conditions, the systolo-diastolic diameter changes observed in the radial artery and the antecubital vein were within a similar range at all time points: 56+/-17 vs 90+/-26 microm (means+/-SEM) at week 12. CONCLUSIONS: The increased circumferential stress resulting from the flow-mediated dilatation rather than the elevation of blood pressure appears to represent the main contributing factor to the eccentric hypertrophy of the venous limb of Brescia-Cimino haemodialysis access.
Keywords
Arteriovenous Shunt, Surgical, Blood Flow Velocity, Blood Pressure, Forearm, Humans, Kidney Failure, Chronic, Male, Muscle, Smooth, Vascular, Radial Artery, Renal Dialysis
Pubmed
Web of science
Open Access
Yes
Create date
29/01/2008 14:00
Last modification date
25/09/2019 7:09
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