Bioinformatics identifies predictors of arteriovenous fistula maturation

Temporal evolution of hemodynamics in murine arteriovenous fistula: a micro-CT based computational fluid dynamics study

In this study, we investigated the hemodynamic characteristics of arteriovenous fistulae (AVF) in murine models using micro-CT based computational fluid dynamics (CFD). By combining high-resolution micro-CT imaging with ultrasound flow measurements, our methodology offers a cost-effective and efficient alternative to traditional MRI-based approaches. CFD simulations performed at 7 and 21 days post-surgery revealed significant temporal changes in both geometry and hemodynamics. Geometric analysis showed that: the proximal artery diameter increased from 0.29 mm to 0.38 mm, while the initial 2 mm fistula segment showed a 21.6% decrease (0.74 mm to 0.58 mm). Blood flow through the AVF nearly doubled from 1.33 mL/min to 2.57 mL/min. Time-averaged wall shear stress (TAWSS) peak values increased from 142 Pa (day 7) within the proximal artery to 200 Pa (day 21), in the stenotic region. The oscillatory shear index (OSI) showed marked elevation at the anastomosis (increasing from 0.22 to 0.48), indicating disturbed flow development. An inverse relationship between TAWSS and OSI was identified consistent with previous studies. Our methodology demonstrates the capability to analyze relationships between early hemodynamics and subsequent geometric changes. This approach could enable identification of regions susceptible to stenosis development and monitoring of AVF maturation, which could ultimately lead to quantitative metrics to evaluate surgical outcomes and early therapeutic interventions.

The role of cellular senescence in endothelial dysfunction and vascular remodelling in arteriovenous fistula maturation

Haemodialysis (HD) is often required for patients with end-stage renal disease. Arteriovenous fistulas (AVFs), a surgical procedure connecting an artery to a vein, are the preferred vascular access for HD due to their durability and lower complication rates. The aim of AVFs is to promote vein remodelling to accommodate increased blood flow needed for dialysis. However, many AVFs fail to mature properly, making them unsuitable for dialysis. Successful maturation requires remodelling, resulting in an increased luminal diameter and thickened walls to support the increased blood flow. After AVF creation, haemodynamic changes due to increased blood flow on the venous side of the AVF initiate a cascade of events that, when successful, lead to the proper maturation of the AVF, making it suitable for cannulation. In this process, endothelial cells play a crucial role since they are in direct contact with the frictional forces exerted by the blood, known as shear stress. Patients requiring HD often have other conditions that increase the burden of senescent cells, such as ageing, diabetes and hypertension. These senescent cells are characterized by irreversible growth arrest and the secretion of pro-inflammatory and pro-thrombotic factors, collectively known as the senescence-associated secretory phenotype (SASP). This accumulation can impair vascular function by promoting inflammation, reducing vasodilatation, and increasing thrombosis risk, thus hindering proper AVF maturation and function. This review explores the contribution of senescent endothelial cells to AVF maturation and explores potential therapeutic strategies to alleviate the effects of senescent cell accumulation, aiming to improve AVF maturation rates.

Increased expression of the P2Y12 receptor is involved in the failure of autogenous arteriovenous fistula caused by stenosis

OBJECTIVE

This study investigated the role of the P2Y12 receptor in autogenous arteriovenous fistula (AVF) failure resulting from stenosis.

METHODS

Stenotic venous tissues and blood samples were obtained from patients with end-stage renal disease (ESRD) together with AVF stenosis, while venous tissues and blood samples were collected from patients with ESRD undergoing initial AVF surgery as controls. Immunohistochemistry and/or immunofluorescence techniques were utilized to assess the expression of P2Y12, transforming growth factor-β1 (TGF-β1), monocyte chemotactic protein 1 (MCP-1), and CD68 in the venous tissues. The expression levels of P2Y12, TGFβ1, and MCP-1 were quantified using quantitative reverse transcription-polymerase chain reaction and western blot analyses. Double and triple immunofluorescence staining was performed to precisely localize the cellular localization of P2Y12 expression.

RESULTS

Expression levels of P2Y12, TGFβ1, MCP-1, and CD68 were significantly higher in stenotic AVF venous tissues than in the control group tissues. Double and triple immunofluorescence staining of stenotic AVF venous tissues indicated that P2Y12 was predominantly expressed in α-SMA-positive vascular smooth muscle cells (VSMCs) and, to a lesser extent, in CD68-positive macrophages, with limited expression in CD31-positive endothelial cells. Moreover, a subset of macrophage-like VSMCs expressing P2Y12 were observed in both stenotic AVF venous tissues and control venous tissues. Additionally, a higher number of P2Y12+/TGF-β1+ double-positive cells were identified in stenotic AVF venous tissues than in the control group tissues.

CONCLUSION

Increased expression of P2Y12 in stenotic AVF venous tissues of patients with ESRD suggests its potential involvement in the pathogenesis of venous stenosis within AVFs.