Semiquantitative analysis of virtual histology derived from intravascular ultrasound images at vascular access stenosis

Vascular access failure, such as recurrent stenosis and thrombosis, is a major concern in patients with end-stage kidney disease. Neointimal hyperplasia development at the anastomosis site of outflow vessels is a primal cause for recurrent vascular access failure. We previously shed some lights into a role of vitamin D, which exerts a protective effect against neointimal hyperplasia formation. Virtual histology, derived from intravascular ultrasound technology, provides novel insights into plaque composition analysis in atherosclerotic diseases. However, there is so far a lack of evidence on the relation between virtual histology and pathophysiological findings. To elucidate this missing link, we comprehensively reviewed 10 chronic hemodialysis patients who underwent repeated intravascular ultrasound–guided balloon angioplasty. Their age, dialysis vintage, and follow-up period were 75.0 ± 4.24, 20.5 ± 2.12, and 11.5 ± 0.71 (mean ± standard deviation) years, respectively. Pathological cross-sectional analyses were performed using specimens from vascular access surgeries during the follow-up period. Interestingly, positive relation is found between virtual histology–constructed fibrous tissue and pathological neointimal hyperplasia. Strikingly, immunohistological analysis revealed that vitamin D receptor–positive myofibroblasts were abundantly distributed in the equivalent area to virtual histology fibrous tissue. Our 10-year follow-up data of resistant vascular access stenosis indicates strong correlation between vitamin D receptor–rich neointimal vessel hypertrophy and intravascular ultrasound–assisted virtual histological analysis. Intravascular ultrasound technology is one of the minimally invasive diagnostic tools to provide histologically relevant tissue structure information and help determine target vessel stenosis on vascular access.