The needle-puncture mouse aortocaval AVF model: a state of the art review

Recent advances using the mouse needle-puncture aortocaval arteriovenous fistula (AVF) model have enhanced our understanding of the complex pathological changes occurring at the juxta-anastomotic area. Some of these changes include the presence of disturbed arteriovenous flow, formation of arteriovenous thrombus as well as eccentric and heterogeneous neointima, and development of an AVF inflow artery aneurysm; the heterogeneous nature of the vein wall reflects both adaptation and maladaptation during vascular remodeling. This technically straightforward AVF model effectively recapitulates human AVF biology, particularly of the emerging endovascular AVF procedure, offering advantages over conventional sutured AVF models. Because the technical complexity of sutured AVF models has limited applicability, we review the needle-puncture AVF model, highlighting technical considerations, methodological approaches, and practical applications. We propose that this model provides a valuable tool to study the mechanisms underlying AVF maturation and failure, with potential translational relevance to improve the clinical outcomes of vascular access.