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Removal of an Intravesical Gellhorn Pessary and Staged Repair of a Residual Large Vesico-Vaginal Fistula
Published on: April 14, 2026
Weighing in on fistula failure
1Veterans Affairs Medical Center, Nephrology Division, University of Iowa School of Medicine, Iowa City, Iowa 52242-1081, USA. bradley-dixon@uiowa.edu
Kidney International
|December 15, 2006
Summary
Obesity may impact vascular access survival by complicating cannulation and releasing adipokines that promote neointimal hyperplasia and thrombosis. These factors contribute to fistula failure, a critical concern in hemodialysis.
Area of Science:
- Nephrology
- Vascular Surgery
- Endocrinology
Background:
- Vascular access is crucial for hemodialysis, with fistula survival being a primary concern.
- Obesity is increasingly prevalent and may affect patient outcomes, including fistula longevity.
- The direct impact of obesity on arteriovenous fistula (AVF) failure is not well-established.
Discussion:
- Obesity presents technical challenges for fistula cannulation, potentially increasing complication risks.
- Obesity is associated with altered levels of adipokines (e.g., IL-6, TNF-α, PAI-1, adiponectin).
- These adipokines may promote vascular inflammation, neointimal hyperplasia, and thrombosis, contributing to fistula failure.
Key Insights:
- Obesity can indirectly impair fistula survival through cannulation difficulties.
- Obesity-related adipokines may accelerate pathological processes leading to fistula failure.
- Further research is needed to quantify the independent contribution of obesity to fistula failure.
Outlook:
- Investigating obesity management strategies to improve fistula survival.
- Developing novel therapeutic targets to mitigate adipokine-induced vascular damage.
- Longitudinal studies are required to confirm the association between obesity and AVF outcomes.
