The effect of flow changes on the arterial system proximal to an arteriovenous fistula for hemodialysis

Arterial remodeling in response to flow changes is controlled by the endothelium, sensing wall shear stress ( SS) changes. The present study focuses on the remodeling capacities of the brachial (BA) and radial artery (RA) of 16 renal failure patients after arteriovenous fistula creation. Pre- and postoperatively at predetermined time-points, diameter, wall thickness and peak and mean SS were assessed. After arteriovenous fistula creation, acute increases in BA SS ( p = 0.018) and lumen diameter ( p = 0.028) were observed. The diameter further increased in the next year ( p = 0.023), whereas BA SS remained unchanged. RA SS and diameter increased acutely ( p = 0.005) and remained unaltered after 1 y. RA wall thickness tended to decrease acutely ( p = 0.059) and increased steadily during 1 y ( p = 0.008). BA and RA diameter acutely increased after an acute SS rise and remained augmented after 1 y. Also, the RA vessel wall thickness enlarged, indicating structural remodeling. After 1 y, however, these changes did not result in SS restoration. (E-mail: j.tordoir@surgery.azm.nl)