Sirolimus-Eluting Stents to Abolish Intimal Hyperplasia and Improve Flow in Porcine Arteriovenous Grafts

Author:

Rotmans Joris I.1,Pattynama Peter M.T.1,Verhagen Hence J.M.1,Hino Ichiro1,Velema Evelyn1,Pasterkamp Gerard1,Stroes Erik S.G.1

Affiliation:

1. From the Experimental Cardiology Laboratory, University Medical Center (J.I.R., E.V., G.P.), and the Department of Vascular Surgery, University Medical Center (J.I.R., H.J.M.V.), Utrecht; the Department of Radiology, Erasmus MC, University Medical Center Rotterdam (P.M.T.P., I.H.); and the Department of Vascular Medicine, Academic Medical Center, Amsterdam (E.S.G.S.), the Netherlands.

Abstract

Background— The patency of arteriovenous (AV) expanded polytetrafluoroethylene (ePTFE) hemodialysis grafts is severely compromised by intimal hyperplasia (IH) at the venous anastomosis and in the venous outflow tract. We addressed the potential of primary placement of a sirolimus-eluting stent (SES) in a validated porcine model. Methods and Results— In 25 pigs, ePTFE AV grafts were created bilaterally between the carotid artery and the jugular vein, whereupon a self-expandable nitinol stent (14 SESs and 11 bare-metal stents) was implanted over the venous anastomosis in 1 of the 2 grafts. After exclusion of technical failures and 1 unilateral occlusion, 16 pigs (9 SESs and 7 bare-metal stents) were included for further analysis. After 28 days, we measured graft flow and performed quantitative angiography. The pigs were then euthanized, and grafts with adjacent vessels were excised for histological analysis. Minimal luminal diameter was substantially larger in the SES group compared with unstented controls (5.9±0.2 versus 3.8±0.4 mm, respectively, P =0.01), which was accompanied by more prominent graft flow (SES, 1360±89 mL/min versus unstented, 861±83 mL/min, P =0.05). IH at the venous anastomosis was 77% less in the SES group compared with unstented controls (0.44±0.05 versus 1.92±0.5 mm 2 , respectively, P =0.01), whereas IH increased markedly when bare-metal stents were used (5.7±1.4 mm 2 , P =0.05). Conclusions— SESs in the venous outflow of AV grafts significantly reduce IH and increase vessel diameter and graft flow compared with unstented grafts. These findings suggest that SESs have the potential to improve primary patency of AV grafts in hemodialysis patients.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

Cited by 63 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3