Tag Archives: av fistula
Hemodialysis.com Author Interview: Dr. Joris I. Rotmans, MD PhD
Department of Nephrology, Leiden University Medical Center,
PO Box 9600, 2300 RC Leiden, The Netherlands
The Einthoven Laboratory
Experimental Vascular Medicine is the workshop of the theme Vascular Medicine
Leiden University Medical Center (LUMC).
Hemodialysis.com: What was the rationale for the study?
Dr. Rotmans: Vascular access dysfunction is currently the Achilles’ heel of hemodialysis therapy. The vast majority of arteriovenous access failure is caused by thrombosis, secondary to disproportionate intimal hyperplasia and impaired outward remodeling of the venous outflow tract. Currently, it is unknown why AVF failure occurs in some individuals but not in others. We investigated whether genetic risk factors might play a role in AVF failure.
Hemodialysis.com: What are the main findings of the study?
Dr. Lassila: Arteriovenous fistulas (AVF) reconstructed for using patient’s own vessels (even without prosthesis material) carry a high risk offailure upon waiting for maturation and for the use for dialysis.
One-year AVF failure rate in Finnish patients treated at Helsinki University Central Hospital (n=219, during 2002-2004) was 32%. Almost half of the failures occurred already prior to fistula use. The high flow rate in fistulas creates conditions where platelets get activated and adhere to the fistula wall. Upon repetitive needle sticks subendothelial matrix is exposed to blood imitating thrombus formation. We were interested in assessing whether coagulation abnormalities (hypercoagulability: e.g. elevated FVIII: C, fibrinogen and D-dimer)) and thrombophilia (factor V Leiden, prothrombin mutation, deficiencies of natural anticoagulants protein C, protein S and antithrombin) were associated with AVF survival.