Factors affecting arteriovenous fistula dysfunction: A narrative review

Area of Science:

• Nephrology
• Vascular Surgery
• Biomedical Engineering

Background:

• Vascular access dysfunction is a primary cause of morbidity, mortality, and high healthcare costs in haemodialysis patients.
• It accounts for up to one-third of hospitalizations among these patients.
• Advances in understanding arteriovenous fistula (AVF) maturation and failure have spurred research into prevention and treatment strategies.

Purpose of the Study:

• To review the pathogenesis of vascular access failure.
• To provide a comprehensive analysis of risk factors and causes of AVF failure.
• To interpret potential future therapeutic approaches.

Main Methods:

• Literature review and synthesis of current research on vascular access dysfunction.
• Analysis of mechanisms underlying AVF maturation and failure.
• Examination of contributing factors including inflammation and cellular processes.

Main Results:

• AVF failure is multifactorial, involving upstream and downstream events leading to venous neo-intimal hyperplasia and/or inadequate outward remodeling.
• Inflammation is central to AVF dysfunction, though specific triggers require further elucidation.
• Risk factors and causes are complex, necessitating a multifaceted approach to prevention and treatment.

Conclusions:

• Further research into AVF failure mechanisms is imperative for improving patient care.
• Enhanced prevention, surveillance, and treatment strategies are needed to improve patient prognosis.
• Targeting inflammatory pathways and understanding triggers may offer future therapeutic avenues.