Flow-Induced High-frequency Vascular Wall Vibrations: A New Mechanobiological Stimulus for Vascular Remodeling?

Despite substantial progress in vascular access research, the mechanobiological mechanisms driving adverse remodeling of vascular walls, such as intimal hyperplasia, remain unclear. Native arteriovenous fistula (AVF), the preferred vascular access for hemodialysis, represents an ideal condition to investigate the effect of hemodynamic changes on vascular cells' biological functions. Our recent work provides converging evidence that disturbed venous flow in AVFs not only triggers endothelial dysfunction but also induces high‑frequency mechanical vibrations within the vessel wall. These vibrations may directly influence smooth muscle cell proliferation, phenotype, and overall wall remodeling. This review summarizes relevant work in the field and calls for a paradigm shift in future AVF research: moving beyond the role of hemodynamic shear stress on the endothelium and considering the role of vibration‑related mechanobiological stimuli in these pathological processes acting throughout the entire vascular wall and involving all vascular cell phenotypes.