Centered endovascular irradiation to prevent postangioplasty restenosis of arteriovenous fistula in hemodialysis patients

Krueger, Karsten; Bendel, Mark; Zaehringer, Markus; Reinicke, G.; Lackner, K.

doi:10.1016/j.carrad.2004.02.005

Cited by 5 publications

(2 citation statements)

References 31 publications

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“…In a porcine model of hemodialysis AV grafts, local delivery of gamma radiation reduced NH at the venous anastomosis 223. Despite these encouraging data, recent clinical trials in hemodialysis patients failed to demonstrate significant inhibition of stenosis by radiation treatment of native AV fistulas or ePTFE grafts 224,225…”

Section: Prevention Strategiesmentioning

confidence: 99%

Neointimal hyperplasia associated with synthetic hemodialysis grafts

Terry

Shiu

et al. 2008

Kidney International

114

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Stenosis is a major cause of failure of hemodialysis vascular grafts and is primarily caused by neointimal hyperplasia (NH) at the anastomoses. The objective of this article is to provide a scientific review of the biology underlying this disorder and a critical review of the state-of-the-art investigational preventive strategies in order to stimulate further research in this exciting area. The histology of the NH shows myofibroblasts (that are probably derived from adventitial fibroblasts), extracellular matrices, pro-inflammatory cells including foreign-body giant cells, a variety of growth factors and cytokines, and neovasculature. The contributing factors of the pathogenesis of NH include surgical trauma, bioincompatibility of the synthetic graft, and the various mechanical stresses that result from luminal hypertension and compliance mismatch between the vessel wall and graft. These mechanical stimuli are focal in nature and may have a significant influence on the preferential localization of the NH. Novel mechanical graft designs and local drug delivery strategies show promise in animal models in preventing graft NH development. Successful prevention of graft stenosis would provide a superior alternative to the native fistula as hemodialysis vascular access.

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Section: Prevention Strategiesmentioning

confidence: 99%

Neointimal hyperplasia associated with synthetic hemodialysis grafts

Terry

Shiu

et al. 2008

Kidney International

114

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“…The method, which was pioneered (42) in hypercholesterolemic rabbit model, is classified as a sealed-source radiotherapeutic procedure, and it is known as endovascular (or intravascular) brachytherapy. Following animal experimentation, it has been applied episodically for treating stenosis associated with NIH in venous grafts including AVF, with variable outcomes (13,24,(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54). However, there is no clear evidence that the radiation therapies based suppressing the intimal SMCs had lasting benefits in preventing stenosis.…”

Section: Introductionmentioning

confidence: 99%

Therapeutic strategies based on non-ionizing radiation to prevent venous neointimal hyperplasia: the relevance for stenosed arteriovenous fistula, and the role of vascular compliance

Russu,

Arbanasi,

Chirila

et al. 2024

Front. Cardiovasc. Med.

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We have reviewed the development and current status of therapies based on exposure to non-ionizing radiation (with a photon energy less than 10 eV) aimed at suppressing the venous neointimal hyperplasia, and consequentially at avoiding stenosis in arteriovenous grafts. Due to the drawbacks associated with the medical use of ionizing radiation, prominently the radiation-induced cardiovascular disease, the availability of procedures using non-ionizing radiation is becoming a noteworthy objective for the current research. Further, the focus of the review was the use of such procedures for improving the vascular access function and assuring the clinical success of arteriovenous fistulae in hemodialysis patients. Following a brief discussion of the physical principles underlying radiotherapy, the current methods based on non-ionizing radiation, either in use or under development, were described in detail. There are currently five such techniques, including photodynamic therapy (PDT), far-infrared therapy, photochemical tissue passivation (PTP), Alucent vascular scaffolding, and adventitial photocrosslinking. The last three are contingent on the mechanical stiffening achievable by the exogenous photochemical crosslinking of tissular collagen, a process that leads to the decrease of venous compliance. As there are conflicting opinions on the role of compliance mismatch between arterial and venous conduits in a graft, this aspect was also considered in our review.

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Hämodialyseshunt

Wittenberg¹

Kardiovaskuläres System

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Centered endovascular irradiation to prevent postangioplasty restenosis of arteriovenous fistula in hemodialysis patients

Cited by 5 publications

References 31 publications

Neointimal hyperplasia associated with synthetic hemodialysis grafts

Neointimal hyperplasia associated with synthetic hemodialysis grafts

Therapeutic strategies based on non-ionizing radiation to prevent venous neointimal hyperplasia: the relevance for stenosed arteriovenous fistula, and the role of vascular compliance

Hämodialyseshunt

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