Therapy May Prevent Vessel Narrowing that Causes Fistula Failure in Dialysis Patients.

Anti-VEGF-A therapies given at the time of fistula creation may help reduce venous neointimal hyperplasia (which causes venous stenosis) in dialysis patients, according to a Kidney International study. Using a lentivirus-delivered small-hairpin RNA that inhibits VEGF-A expression was associated with a significant increase in average lumen vessel area, decreased media/adventitia area, and decreased constrictive remodeling with a significant increase in cell death, as well as decreased cellular proliferation and hypoxia-inducible factor-1α at the outflow vein. There was also a significant decrease in cells staining positive for α-smooth muscle actin (a myofibroblast marker) and VEGFR-1 expression with a decrease in matrix metalloproteinases.