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Preexisting Venous Calcification Prior to Dialysis Vascular Access Surgery

Authors

  • Timmy Lee,

    1. Department of Internal Medicine and Division of Nephrology and Hypertension, University of Cincinnati, Ohio
    2. Cincinnati Veterans Administration Medical Center, Cincinnati, Ohio
    3. Dialysis Vascular Access Research Group Cincinnati, Ohio
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  • Nida Safdar,

    1. Department of Internal Medicine and Division of Nephrology and Hypertension, University of Cincinnati, Ohio
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  • Meenakshi J. Mistry,

    1. Department of Internal Medicine and Division of Nephrology and Hypertension, University of Cincinnati, Ohio
    2. Dialysis Vascular Access Research Group Cincinnati, Ohio
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  • Yang Wang,

    1. Department of Internal Medicine and Division of Nephrology and Hypertension, University of Cincinnati, Ohio
    2. Dialysis Vascular Access Research Group Cincinnati, Ohio
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  • Vibha Chauhan,

    1. Department of Internal Medicine and Division of Nephrology and Hypertension, University of Cincinnati, Ohio
    2. Dialysis Vascular Access Research Group Cincinnati, Ohio
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  • Begoña Campos,

    1. Department of Internal Medicine and Division of Nephrology and Hypertension, University of Cincinnati, Ohio
    2. Dialysis Vascular Access Research Group Cincinnati, Ohio
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  • Rino Munda,

    1. Dialysis Vascular Access Research Group Cincinnati, Ohio
    2. Department of Surgery, University of Cincinnati, Ohio
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  • Virgilius Cornea,

    1. Department of Pathology, University of Cincinnati, Ohio
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  • Prabir Roy-Chaudhury

    1. Department of Internal Medicine and Division of Nephrology and Hypertension, University of Cincinnati, Ohio
    2. Cincinnati Veterans Administration Medical Center, Cincinnati, Ohio
    3. Dialysis Vascular Access Research Group Cincinnati, Ohio
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  • Timmy Lee and Nida Safdar contributed equally to this manuscript.

Address correspondence to: Timmy Lee, M.D., M.S.P.H., F.A.C.P., F.A.S.N., Assistant Professor of Clinical Medicine, Department of Internal Medicine, Division of Nephrology and Hypertension, University of Cincinnati, 231 Albert Sabin Way, M.L.0585, Cincinnati, OH 45267-0585, Tel.: 513-558-4782, Fax: 513-558-4309, or e-mail: timmy.lee@uc.edu.

Abstract

Vascular calcification is present in arterial vessels used for dialysis vascular access creation prior to surgical creation. Calcification in the veins used to create a new vascular access has not previously been documented. The objective of this study was to describe the prevalence of venous calcification in samples collected at the time of vascular access creation. Sixty-seven vein samples were studied. A von Kossa stain was performed to quantify calcification. A semi-quantitative scoring system from 0 to 4+ was used to quantify the percentage positive area for calcification as a fraction of total area (0: 0; 1+: 1–10%; 2+: 11–25%; 3+: 26–50%; 4+: >50% positive). Twenty-two of 67 (33%) samples showed evidence of venous calcification. Histologic examination showed varying degrees of calcification within each cell layer. Among the subset of patients with calcification, 4/22 (18%), 19/22 (86%), 22/22 (100%), and 7/22 (32%) had calcification present within the endothelium, intima, media, and adventitia, respectively. The mean semi-quantitative scores of the 22 samples with calcification were 0.18 ± 0.08, 1.2 ± 0.14, 1.6 ± 0.13, and 0.36 ± 0.12 for the endothelium, intima, media, and adventitia, respectively. Our results demonstrate that vascular calcification is present within veins used to create new dialysis vascular access, and located predominately within the neointimal and medial layers.

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