Long-term arterial adaptation to high blood flow in the feeding artery of vascular access for hemodialysis
Long-term arterial adaptation to high blood flow in the feeding artery of vascular access for hemodialysis
J Vasc Access 2012; 13(3): 305 - 309
DOI:10.5301/jva.5000048
Authors
Vladimir Tuka, Jan Malik, Eva Chytilova, Jaroslav Kudlicka, Marcela Slavikova, Edwin Wijnen, Jan H.M. Tordoir, Simon Van Hooland
Abstract
Purpose: Arteries continuously respond to changing tissue demands and to hemodynamic conditions by altering their diameter and wall structure. The relatively slow dilatation of the feeding artery of vascular accesses continues at least two years after access creation with a continuous decrease in wall shear rate (WSR), which however, remains highly supra-physiological. The aim of this study was to test the hypothesis that after a longer time period the WSR returns to its baseline value. Methods: In a cross-sectional study patients with arteriovenous fistulae were classified into four groups according to the access vintage (from new access to accesses older than six years). The WSR, cross-sectional area, and mean circumferential wall stress were measured and compared between groups.Results: WSR decreased from group 1 (fistula < ninety days old) to group 4 (fistulae > six years old) with a concomitant increase in internal diameter. Patients with the oldest access had normal WSR values (compared to the contralateral brachial artery) and the largest internal diameter of the feeding artery. In diabetic patients the absolute values of WSR were higher and internal diameter was lower compared to nondiabetic patients.Conclusions: Brachial artery WSR is normal in accesses older than six years with an increased internal diameter and wall cross-sectional area as compared to “younger” accesses. This suggests a process of vascular remodeling with an increase in vascular wall mass and normalization of WSR to physiologic values at the price of increased mean cross-sectional wall stress.
Article History
- • Accepted on 28/11/2011
- • Available online on 16/01/2012
- • Published in print on 28/09/2012
Article usage statistics
The blue line displays unique views in the time frame indicated.
The yellow line displays unique downloads.
Views and downloads are counted only once per session.
Authors
-
Tuka, Vladimir [PubMed] [Google Scholar]
Third Department of Internal Medicine,General University Hospital and First Faculty of Medicine, Charles University, Prague - Czech Republic
-
Malik, Jan [PubMed] [Google Scholar]
Third Department of Internal Medicine,General University Hospital and First Faculty of Medicine, Charles University, Prague - Czech Republic
-
Chytilova, Eva [PubMed] [Google Scholar]
Third Department of Internal Medicine,General University Hospital and First Faculty of Medicine, Charles University, Prague - Czech Republic
-
Kudlicka, Jaroslav [PubMed] [Google Scholar]
Third Department of Internal Medicine,General University Hospital and First Faculty of Medicine, Charles University, Prague - Czech Republic
-
Slavikova, Marcela [PubMed] [Google Scholar]
Department of Cardiovascular Surgery, General University Hospital and First Faculty of Medicine, Charles University, Prague - Czech Republic
-
Wijnen, Edwin [PubMed] [Google Scholar]
Department of Internal Medicine, Division of Nephrology, Viecuri Hospital, Venlo - The Netherlands
-
Tordoir, Jan H.M. [PubMed] [Google Scholar]
Department of Surgery, University Hospital Maastricht, Maastricht - The Netherlands
-
Van Hooland, Simon [PubMed] [Google Scholar]
Department of Nephrology; AZ St Lucas, Ghent - Belgium