Maintenance of adequate hemodialysis access. Prevention of neointimal hyperplasia

T. E. Taber, P. S. Maikranz, B. W. Haag, G. M. Gaylord, R. S. Dilley, K. O. Ehrman, P. B. Brown, D. R. Nelson, D. C. Kay, T. L. Roberts, J. M. Huse, L. T. Micon, L. H. Stevens

Research output: Contribution to journalArticle

17 Scopus citations

Abstract

The maintenance of adequate hemodialysis vascular access is frequently complicated in the patient with polytetrafluoroethylene (PTFE) A-V hemodialysis grafts by venous anastomotic stenosis. This stenosis is caused by neointimal hyperplasia (NIH), a response to vascular injury. In this study, the authors prospectively analyzed the effect of a short-term regimen consisting of administration of two medications, heparin and low molecular weight dextran, on the development of NIH at the venous anastomosis in 79 patients with PTFE A-V hemodialysis grafts. In addition, they evaluated other parameters' effects on the development of NIH. In comparison with control subjects, heparin had some effect in minimizing the development of NIH in the PTFE grafts when evaluated radiologically at 3 months, although this effect was not statistically significant. Low molecular weight dextran, however, had no trend or statistically significant effect on this venous anastomotic narrowing. Interestingly, patient age, use of calcium channel blockers, and presence of diabetes mellitus (DM) all appeared to affect the development of NIH. Increasing age and use of calcium channel blockers was associated with decreased development of NIH; conversely, DM was associated with worsened NIH. In evaluation of access survival (time to first access failure), degree of venous anastomosis stenosis at 3 months was not predictive. Patient time on dialysis pre graft placement was the only measured parameter related to access failure. The method of dialysis pre graft placement (hemodialysis versus peritoneal dialysis) was not a significant factor in early access failure. Pharmacologic treatment of venous anastomotic narrowing in PTFE hemodialysis grafts due to NIH continues to be difficult. Short-term treatment with the tested medication failed to statistically affect NIH. Patient age, use of calcium channel blockers, and presence of DM were all factors in the development of NIH. Of measured parameters, time on dialysis pre graft placement was the only factor correlated with early access failure. In future treatment regimens, one should consider more prolonged treatment. In addition, noted risk factors should be considered when determining type of renal replacement therapy.

Original languageEnglish (US)
Pages (from-to)842-846
Number of pages5
JournalASAIO Journal
Volume41
Issue number4
DOIs
StatePublished - Nov 29 1995
Externally publishedYes

ASJC Scopus subject areas

  • Biophysics
  • Bioengineering
  • Biomaterials
  • Biomedical Engineering

Fingerprint Dive into the research topics of 'Maintenance of adequate hemodialysis access. Prevention of neointimal hyperplasia'. Together they form a unique fingerprint.

  • Cite this

    Taber, T. E., Maikranz, P. S., Haag, B. W., Gaylord, G. M., Dilley, R. S., Ehrman, K. O., Brown, P. B., Nelson, D. R., Kay, D. C., Roberts, T. L., Huse, J. M., Micon, L. T., & Stevens, L. H. (1995). Maintenance of adequate hemodialysis access. Prevention of neointimal hyperplasia. ASAIO Journal, 41(4), 842-846. https://doi.org/10.1097/00002480-199510000-00005