Smooth muscle changes in the cephalic vein of renal failure patients before use as an arteriovenous fistula (AVF).

Complications in arteriovenous fistula (AVF) occur in up to 35% of renal failure patients on hemodialysis. The most frequent complication is thrombosis, usually from stenotic lesions in the venous outflow system. To study the pre-existing smooth muscle changes in the cephalic vein of these patients, we prospectively collected a total of 17 cephalic vein specimens from 3 normal controls and 14 renal failure patients undergoing primary AVF construction on the chosen limb. After preparation, ultrathin sections were stained with uranyl and lead acetate and were examined under the transmission electron microscope (TEM). Compared with the normal controls, abnormal fibrous infiltration of the intima and the media and varying degrees of smooth muscle degenerative changes were observed in all the cephalic vein sections of renal failure patients. Smooth muscle cells (SMCs) lost their normal fusiform shape and were widely separated by increased amount of irregularly disposed, extracellular collagen fibers. Other cellular abnormalities included irregular cell membrane, granular cytoplasm, Peri- and Paranuclear vacuoles and mega mitochondria. SMCs also showed morphological expression of phagocytosis of collagen and elastic fibers as a sign of remodeling of the vein wall. In conclusion, pre-existing wall and smooth muscle changes were observed in all the cephalic vein sections of renal failure patients, which may contribute to the later complications of AVFs.