Description
Title: Arteriovenous Fistula Access for Hemodialysis Use: Localized Perivascular Therapeutic Approaches to Inhibit Venous Neointimal Hyperplasia
Abstract: The preferred vascular access for chronic hemodialysis is an arteriovenous fistula (AVF), but its use is constrained by high failure rates. Primary AVF failure rates in clinical practice have not been significantly decreased despite efforts to improve patients’ perioperative status and surgical technique. Neointimal hyperplasia (NIH), a condition brought on by the concomitant effects of inflammation, hypoxia, and hemodynamic shear stress on vascular tissue, is one of the main reasons for AVF failure. Although several systemic therapies have been developed to suppress NIH, none have demonstrated a distinct advantage in this regard. By directly supporting the maturing fistula’s structural and functional needs, as well as by administering higher doses of pharmacologic agents without the side effects associated with systemic administration of therapeutic agents, localized therapeutic approaches may increase the rate at which AVFs mature. Novel materials, like nanoparticles and polymeric scaffolds, have made it possible to create a variety of perivascular therapies, including mechanical devices for support, targeted drug delivery, and cell-based therapies. In the context of AVF for hemodialysis use, we summarize various perivascular therapeutic approaches, data on their efficacy that is currently available, and the outlook for localized therapies targeting NIH in this review. Highlights: Localized therapeutic strategies may be advantageous because the majority of systemic therapies do not improve AVF patency outcomes. By providing biological and mechanical support, locally delivered pharmaceuticals and medical equipment may enhance AVF patency outcomes. By delivering a wider variety of bioactive substances in response to the biochemical changes in the AVF microenvironment, cell-based therapies have shown promise in suppressing NIH.
Keywords: arteriovenous fistula; cell- and tissue-based therapy; chronic kidney disease; drug delivery systems; end-stage renal disease; hemodialysis; neointimal hyperplasia
Paper Quality: SCOPUS / Web of Science Level Research Paper
Subject: Biomolecules
Writer Experience: 20+ Years
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