Specialty Care, Charlie Norwood VA Medical Center, and Section of Nephrology, Department of Medicine, Georgia
Regents University, Augusta, Georgia, USA
The vasculopathy of ESRD affects both arteries and veins. The arteries develop arteriosclerosis, which is
largely a disease of the media characterized by increased collagen content, calcification, and both hypertrophy and
hyperplasia of vascular smooth muscle cells. Veins may exhibit increased width of the intimal and medial layers, and may
develop neointimal hyperplasia and calcification. Successful fistula maturation depends upon dilatation and remodeling of
the artery and vein, but the stiff and thickened vessels of ESRD patients may respond poorly to signals that promote these
adaptations. There is intense interest in accurately predicting fistula maturation outcome and preventing maturation
failure. However, definitive criteria for preoperative testing of vessel elasticity have not yet been established. Tests that
are adopted for widespread clinical use will need to be easy to apply - a standard that many of these tests may not meet.
Finally, effective treatments are needed that prevent or reduce the stiffness of vessels. In conclusion, although there are
many promising developments in this emerging field, effective methods of predicting fistula maturation outcome and
preventing maturation failure remain to be established.
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