关键词: 血液透析, 血管通路, 动静脉内瘘, 人造血管, 内膜增生

Abstract: 【Abstract】Vascular access is the "lifeline" to hemodialysis patients. The basic and clinical knowledge of vascular access progresses rapidly in recent years. Neointimal hyperplasia is now recognized as the main cause of vascular access dysfunction. Upstream events such as vascular wall injury, hemodynamic changes and endothelial dysfunction trigger a series of downstream pathophysiological processes in the context of chronic kidney disease. Eventually, the secondary neointimal hyperplasia leads to vascular access dysfunction or maturation failure. Surgical modification and percutaneous transluminal plasty of the dysfunctional AVF are the hot spots in the field of vascular access reconstruction. Endovascular technologies such as balloon-assisted maturation, accessory vein occlusion and stent placement are gradually opening up new prospects for maintenance and repair of vascular access. A variety of systemic drug intervention and local vascular wrap technologies have obtained some achievements for the clinical prevention and treatment of neointimal hyperplasia in vascular access. Tissue-engineered blood vessel grafts as vascular access have showed better safety and patency, and are worthy of further clinical study.

Key words: hemodialysis, vascular access, arteriovenous fistula, graft, neointimal hyperplasia