الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Arteriovenous fistulae are the preferred type of vascular access for end-stage renal disease patients requiring hemodialysis. Vascular access problems are among the major causes of morbidity and mortality in ESRD patients. Primary non-function of AVFs may reach rates as high as 50%, yet its underlying mechanism remains poorly defined. The most common lesion in primary non-function is stenosis at the juxta-anastomotic region caused by vasoconstriction and/or neointimal hyperplasia. Beside surgical trauma, uremia and other related factors like endothelial dysfunction, oxidative stress, and chronic inflammation may all play a role in the pathogenesis of primary non-function of AVFs. Pathological changes in patients’ veins before AVF creation have also been demonstrated further predisposing patients to early AVF failure.
The aim of the present study was to assess pathological and histopathological morphology of veins of ESRD patients before AVF creation and to correlate the findings to AVF outcome and the patient survival. The study also aimed to explore the effect of oxidative stress, endothelial dysfunction, inflammation and other demographic, clinical and laboratory variables.
The study included 34 patients with ESRD presenting to the Vascular Surgery Department of the Main University Hospital of Alexandria University for AVF creation. After obtaining an informed consent, the patients were subjected to history taking, clinical examination and blood sampling for laboratory assessment. Endothelial function was assessed in a subgroup of 10 patients using flow-mediated dilatation measurement. Oxidative stress was assessed by estimating the level of p22phox mRNA expression by real-time quantitative reverse transcriptase PCR in the mononuclear cells of the patients. During the surgical procedure, a venous tissue sample was obtained from the ligated distal vein for pathological and immunohistochemical examination. The patients were followed up at 1-3 months for the primary function of the AVF and again at 3-6 months. Nine patients agreed to attend a Doppler ultrasonographic examination of their AVF. Three venous tissue control specimens were obtained from patients presenting for upper limb trauma. In addition, 5 control blood samples were obtained for p22phox mRNA expression estimation.
The studied patients had a mean age of 50.26 ± 13.80 years. About 60% of the studied patients were male, and 35.3% smokers. A history of previous central venous catheterization was p