MORPHOLOGICAL ALTERATIONS OF THE CEPHALIC VEIN WALL AS A PAT OF A NATIVE RTERIOVENOUS FISTULA FOR CHRONIC HEMODIALYSIS

The creation of an internal arterio-venous fistula according to Brescia and Cimino (1966) changes the functional conditions of cephalic vein and radial artery. Arterial blood enters under high pressure the cephalic vein and turbulent blood flow appears. The pathomorphology of the cephalic vein incorporated in the internal native arterio-venous fistula (NAVF) for chronic hemodialysis was studied. Single portions of the vein were surgically removed from 16 patients aged from 20 to 60 years with failed NAVF and then excised because of repeated NAVF creation (group one) and from 3 patients where the vein was removed during the primary NAVF creation (group two). Light and transmission electron microscopy was used. In the first group, the intima and media of the cephalic vein was much ticker than that of the veins of the patients of the second and control group. The increased thickness of the venous intima was accompanied by an augmented number of smooth muscles cells and appearance of new layers while that of the media was followed by structural changes of its elastic network. These alterations depend on the duration of NAVF functioning.