{"doi":"10.1126/scitranslmed.aax7613","title":"Artery to vein configuration of arteriovenous fistula improves hemodynamics to increase maturation and patency","abstract":"Arteriovenous fistulae (AVF) are the preferred mode of hemodialysis access, but 60% of conventional [vein-to-artery (V-A)] AVF fail to mature, and only 50% remain patent at 1 year. We previously showed improved maturation and patency in a pilot study of the radial artery deviation and reimplantation (RADAR) technique that uses an artery-to-vein (A-V) configuration. Here, we show that RADAR exhibits higher rates of maturation, as well as increased primary and secondary long-term patencies. RADAR is also protective in female patients, where it is associated with decreased reintervention rates and improved secondary patency. RADAR and conventional geometries were compared further in a rat bilateral carotid artery-internal jugular vein fistula model. There was decreased cell proliferation and neointimal hyperplasia in the A-V configuration in male and female animals, but no difference in hypoxia between the A-V and V-A configurations. Similar trends were seen in uremic male rats. The A-V configuration also associated with increased peak systolic velocity and expression of Kruppel-like factor 2 and phosphorylated endothelial nitric oxide synthase, consistent with improved hemodynamics. Computed tomography and ultrasound-informed computational modeling showed different hemodynamics in the A-V and V-A configurations, and improving the hemodynamics in the V-A configuration was protective against neointimal hyperplasia. These findings collectively demonstrate that RADAR is a durable surgical option for patients requiring radial-cephalic AVF for hemodialysis access.","journal":"Science Translational Medicine","year":2020,"id":92965,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":41,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9579,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":464933,"name":"Nirvana Sadaghianloo","orcid":"0000-0003-3394-8458","position":1,"is_corresponding":false},{"id":310301,"name":"Jolanta Gorecka","orcid":"0000-0001-9131-3704","position":2,"is_corresponding":false},{"id":464934,"name":"Shirley Liu","orcid":"0000-0003-4777-6917","position":3,"is_corresponding":false},{"id":261118,"name":"Shun Ono","orcid":null,"position":4,"is_corresponding":false},{"id":268874,"name":"Abhay B. Ramachandra","orcid":"0000-0001-6275-501X","position":5,"is_corresponding":false},{"id":464935,"name":"Sophie Bonnet","orcid":"0000-0002-7856-0820","position":6,"is_corresponding":false},{"id":464936,"name":"Nathalie M. Mazure","orcid":"0000-0003-1350-7161","position":7,"is_corresponding":false},{"id":464937,"name":"Serge Declémy","orcid":"0000-0001-5040-7675","position":8,"is_corresponding":false},{"id":245130,"name":"Jay D. Humphrey","orcid":"0000-0003-1011-2025","position":9,"is_corresponding":false},{"id":258727,"name":"Alan Dardik","orcid":"0000-0001-5022-7367","position":10,"is_corresponding":false},{"id":305225,"name":"Hualong Bai","orcid":"0000-0003-4039-414X","position":0,"is_corresponding":true}],"reference_count":61,"raw_metadata":null,"created_at":"2026-07-18T22:30:54.208860Z","pmid":"32817365","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}