Comparative Analysis of Cellular Phenotypes Within the Neointima From Vein Segments Collected Prior to Vascular Access Surgery and Stenotic Arteriovenous Dialysis Accesses

Authors

  • Timmy Lee,

    Corresponding author
    1. Department of Internal Medicine and Division of Nephrology and Hypertension, University of Cincinnati, Cincinnati, OH
    2. Cincinnati Veterans Affairs Medical Center, Cincinnati, OH
    3. Dialysis Vascular Access Research Group, Cincinnati, OH
    4. Department of Medicine and Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL
    • Address correspondence to: Timmy Lee, M.D., M.S.P.H., F.A.C.P., F.A.S.N., Associate Professor of Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, 1720 2nd Ave. South, ZRB 524, Birmingham, AL 35294-0007, Tel.: 205-975-9322, Fax: 205-996-6465, or e-mail: txlee@uab.edu.

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  • Yang Wang,

    1. Department of Internal Medicine and Division of Nephrology and Hypertension, University of Cincinnati, Cincinnati, OH
    2. Dialysis Vascular Access Research Group, Cincinnati, OH
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  • Lois Arend,

    1. Department of Pathology, Johns Hopkins University, Baltimore, MD
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  • Virgilius Cornea,

    1. Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, KY
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  • Begona Campos,

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

    1. Dialysis Vascular Access Research Group, Cincinnati, OH
    2. Department of Surgery and Division of Transplant Surgery, University of Cincinnati, Cincinnati, OH
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  • Prabir Roy-Chaudhury

    1. Department of Internal Medicine and Division of Nephrology and Hypertension, University of Cincinnati, Cincinnati, OH
    2. Cincinnati Veterans Affairs Medical Center, Cincinnati, OH
    3. Dialysis Vascular Access Research Group, Cincinnati, OH
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  • Portions of this work were presented in abstract form at the Vascular Access Society Meeting, Istanbul, Turkey, May 2011 and American Society of Nephrology Renal Week, Philadelphia, PA, November 2011.

Abstract

Venous stenosis, secondary to venous neointimal hyperplasia (VNH), at the arteriovenous anastomosis (AV) is a major etiology of vascular access failure in AV fistulas (AVF) and AV grafts (AVG). Recently, our group has reported that severe VNH also occurs prior to vascular access placement. The objective of this study was to perform a comparison of the cellular phenotypes within the neointima from veins collected from subjects at the time of new vascular access creation and stenotic veins from subjects with failed AVGs and AVFs. Vein samples, collected at the time of new access surgery, and stenotic vein segments, collected at access revision, were evaluated for expression of α-smooth muscle actin (SMA), vimentin, and desmin within the neointima, and quantified using semiquantitative scoring. Within the neointima, the majority of cells from vein samples collected at the time of new access surgery were contractile smooth muscle cells, and veins from stenotic AVF and AVG were predominately myofibroblasts. Our results suggest the possibility of different mechanistic pathways in response to vascular injury that occurs prior to vascular access creation vs. after access creation, and that divergent therapeutic approaches may be needed for treating vascular injury in these two settings.

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