Aim. The objective of this study was to characterize coordinated molecular changes in the structure and composition of the walls of venous segments of arteriovenous (AV) fistulas evoked by overflow. Methods. Venous tissue samples were collected from 6 hemodialysis patients with AV fistulas exposed to overflow and from the normal cephalic veins of 4 other hemodialysis patients. Total RNA was extracted from the venous tissue samples, and gene expression between the 2 groups was compared using Whole Human Genome DNA microarray 44？K. Microarray data were analyzed by GeneSpring GX software and Ingenuity Pathway Analysis. Results. The cDNA microarray analysis identified 397 upregulated genes and 456 downregulated genes. Gene ontology analysis with GeneSpring GX software revealed that biological developmental processes and glycosaminoglycan binding were the most upregulated. In addition, most upregulation occurred extracellularly. In the pathway analysis, the TGF beta signaling pathway, cytokines and inflammatory response pathway, hypertrophy model, and the myometrial relaxation and contraction pathway were significantly upregulated compared with the control cephalic vein. Conclusion. Combining microarray results and pathway information available via the Internet provided biological insight into the structure and composition of the venous wall of overflow AV fistulas. 1. Introduction Arteriovenous (AV) fistulas are very useful for determining optimal blood flow for dialysis, but AV fistulas exposed to overflow are thought to increase cardiac output and cause high-output cardiac failure [1, 2]. Measurement of blood flow via an internal shunt was first developed by Krivitski et al., and the monitoring of blood flow via a shunt has since become widespread [3]. We use this technique to monitor the blood flow of AV fistulas at our hospital and correct overflow AV fistulas with surgery. It is thought that the outflow vein of overflow AV fistulas bears a heavy load: as the vein is exposed to increased arterial flow, the wall dilates, triggering a vascular remodeling process. However, the molecular mechanisms by which the outflow vein is remodeled into a mature fistula remain unclear. By investigating venous remodeling in overflow AV fistulas, candidate genes important to the remodeling process can be discovered and their functional significance investigated. Thus, the identification of relevant genes involved in this process should provide insight into AV fistula maturation. In this study, we performed a cDNA microarray analysis and compared segments of the venous
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