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Oxidative stress pathway during AVF maturation. Surgical creation of an AVF provokes vessel injury with activation of NOX-2, generating reactive oxygen species that stabilizes HIF-1α and generates positive feedback to upregulate NOX-2 expression. HIF-1α also stimulates downstream pathways including HO-1, a regulator of vascular tone, and VEGF-A, a promoter of angiogenesis and arteriogenesis.
