Does Vascular Elasticity Affect Arteriovenous Fistula Maturation?

William D. Paulson*
Specialty Care, Charlie Norwood VA Medical Center, and Section of Nephrology, Department of Medicine, Georgia Regents University, Augusta, Georgia, USA

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Creative Commons License
© William D. Paulson; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Medicine, Georgia Regents University, 1120 15th Street, Augusta, GA 30909, USA; Tel: 706-721-2861; Fax: 706-721-7136


The vasculopathy of ESRD affects both arteries and veins. The arteries develop arteriosclerosis, which is largely a disease of the media characterized by increased collagen content, calcification, and both hypertrophy and hyperplasia of vascular smooth muscle cells. Veins may exhibit increased width of the intimal and medial layers, and may develop neointimal hyperplasia and calcification. Successful fistula maturation depends upon dilatation and remodeling of the artery and vein, but the stiff and thickened vessels of ESRD patients may respond poorly to signals that promote these adaptations. There is intense interest in accurately predicting fistula maturation outcome and preventing maturation failure. However, definitive criteria for preoperative testing of vessel elasticity have not yet been established. Tests that are adopted for widespread clinical use will need to be easy to apply - a standard that many of these tests may not meet. Finally, effective treatments are needed that prevent or reduce the stiffness of vessels. In conclusion, although there are many promising developments in this emerging field, effective methods of predicting fistula maturation outcome and preventing maturation failure remain to be established.

Keywords : Arterial stiffness, arteriosclerosis, arteriovenous fistula, calcification, dialysis access, hemodialysis, vascular access, venous distensibility.