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Article Dans Une Revue Science Translational Medicine Année : 2020

Artery to vein configuration of arteriovenous fistula improves hemodynamics to increase maturation and patency

Résumé

Arteriovenous fistulae (AVF) are the preferred mode of hemodialysis access, but 60% of conventional [vein-to-artery (V-A)] AVF fail to mature, and only 50% remain patent at 1 year. We previously showed improved maturation and patency in a pilot study of the radial artery deviation and reimplantation (RADAR) technique that uses an artery-to-vein (A-V) configuration. Here, we show that RADAR exhibits higher rates of maturation, as well as increased primary and secondary long-term patencies. RADAR is also protective in female patients, where it is associated with decreased reintervention rates and improved secondary patency. RADAR and conventional geometries were compared further in a rat bilateral carotid artery-internal jugular vein fistula model. There was decreased cell proliferation and neointimal hyperplasia in the A-V configuration in male and female animals, but no difference in hypoxia between the A-V and V-A configurations. Similar trends were seen in uremic male rats. The A-V configuration also associated with increased peak systolic velocity and expression of Kruppel-like factor 2 and phosphorylated endothelial nitric oxide synthase, consistent with improved hemodynamics. Computed tomography and ultrasound-informed computational modeling showed different hemodynamics in the A-V and V-A configurations, and improving the hemodynamics in the V-A configuration was protective against neointimal hyperplasia. These findings collectively demonstrate that RADAR is a durable surgical option for patients requiring radial-cephalic AVF for hemodialysis access.

Dates et versions

hal-03429088 , version 1 (15-11-2021)

Identifiants

Citer

Hualong Bai, Nirvana Sadaghianloo, Jolanta Gorecka, Shirley Liu, Shun Ono, et al.. Artery to vein configuration of arteriovenous fistula improves hemodynamics to increase maturation and patency. Science Translational Medicine, 2020, 12 (557), ⟨10.1126/scitranslmed.aax7613⟩. ⟨hal-03429088⟩
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