Abstract 16581: Pre-existing Venous Intimal Hyperplasia Explains Post-operatory Neointima Growth but Fails to Predict Arteriovenous Fistula Failure: The Matched-pair Cohort Study
Introduction: Arteriovenous fistulae (AVF) failure is the most common complication in hemodialysis patients. It compromises dialysis treatment, worsens patients’ quality of life and increases the medical costs associated with the maintenance of vascular accesses. There is a belief that AVF failure is mainly due to occlusive neointimal hyperplasia. This study assesses for the first time the impact of pre-existing venous intimal hyperplasia on post surgical neointima development and AVF function (patency).
Methods and Results: Fifty one patients undergoing two-stage brachiobasilic AVF creation at the University of Miami Hospital and Jackson Memorial Health System were enrolled. Matched pair tissue samples were taken from each patient. The proximal basilic vein was procured during vascular access creation while the second biopsy was obtained at the time of AVF transposition for its superficialization. Tissues were rapidly formalin-fixed and cross-sectioned for histomorphometric measurements of the neointima and media areas. Pre-existing intima hyperplasia was persistent among most basilic veins with neointima to media ratios (N/M) ranging between 0.075 and 0.709 (mean: 0.289). The neointimal lesion size experienced a 2.26 fold increased during fistula maturation (p<0.0001, paired t-test). A general linear regression model controlled for multiple baseline covariates revealed the existing positive correlation between the venous intima hyperplasia and the later neointimal growth in the corresponding AVF (B=0.728, p=0.0311). Unexpectedly, the venous N/M ratio failed to predict primary AVF patency using a COX proportional hazard model that included 9 baseline-covariates (age, gender, time between surgeries, diabetes, previous AVF and catheter, statins, anti-platelet and anti-hypertensive drugs).
Conclusions: While pre-existing intimal hyperplasia correlates with the size of the post-operatory neointima in the AVF as revealed in this matched-pair cohort study, it has no impact on the future AVF function and success.
Author Disclosures: L.A. Escobar: None. M. Tabbara: None. J.C. Duque: None. L. Martinez: None. W. Wu: None. Y. Pan: None. N. Fernandez: None. O. Velazquez: None. L. Salman: None. R.I. Vazquez-Padron: None.
- © 2015 by American Heart Association, Inc.