Suppression of neointimal hyperplasia by sirolimus-eluting expanded polytetrafluoroethylene (ePTFE) haemodialysis grafts in comparison with paclitaxel-coated grafts
| Autor: | Jinsun Hwang, Cheng Zhe Bai, Dae Joong Kim, Insu Baek, Jihye Park, Jong-Sang Park |
|---|---|
| Rok vydání: | 2011 |
| Předmět: |
medicine.medical_specialty
Paclitaxel Swine medicine.medical_treatment Urology Constriction Pathologic Anastomosis Constriction Arteriovenous Shunt Surgical Renal Dialysis Neointima medicine.artery medicine Animals Common carotid artery Polytetrafluoroethylene Cell Proliferation Sirolimus Neointimal hyperplasia Transplantation Hyperplasia business.industry Graft Occlusion Vascular medicine.disease Surgery Stenosis Carotid Arteries surgical procedures operative Nephrology Models Animal Female Vascular Grafting Hemodialysis Jugular Veins business External jugular vein medicine.drug |
| Zdroj: | Nephrology Dialysis Transplantation. 27:1997-2004 |
| ISSN: | 1460-2385 0931-0509 |
| DOI: | 10.1093/ndt/gfr545 |
| Popis: | Background Haemodialysis vascular access dysfunction caused by aggressive venous neointimal hyperplasia is a major problem for haemodialysis patients with synthetic arteriovenous (AV) grafts. Several different strategies to prevent venous stenosis by inhibiting smooth muscle cell proliferation and migration using local delivery of potent antiproliferative agents are currently under investigation. We performed this study to evaluate the efficacy of sirolimus-eluting vascular grafts in preventing stenosis and to compare the effectiveness of sirolimus-coated grafts with that of paclitaxel-coated vascular grafts that we characterized in a previous study. Methods AV grafts were implanted laterally between the common carotid artery and external jugular vein of 14 female Landrace pigs. Three types of grafts were implanted: grafts coated with 1.08 μg/mm(2) sirolimus (low dose, n = 6), grafts coated with 2.41 μg/mm(2) sirolimus (high dose, n = 2) and uncoated control grafts (n = 6). Animals were sacrificed 6 weeks after surgery. Cross-sections of the venous anastomoses were analysed to determine the percentage of luminal stenosis in each group, and immunohistochemistry was performed to identify the cellular phenotypes of the neointimal hyperplasia and tissues adjacent to the implanted grafts. Results Compared with the control group, neointimal hyperplasia in the venous anastomoses of the groups implanted with sirolimus-coated vascular grafts was significantly suppressed without infection. The mean ± standard error values for the percentage of luminal stenosis were 75.7 ± 12.7% in the control group and 22.2 ± 1.41% in the low-dose sirolimus-coated group. Myofibroblasts and fibroblasts were the major cell types found in the neointimal hyperplasia. Conclusions Neointimal hyperplasia was effectively suppressed by sirolimus-eluting grafts. However, the inhibitory effects of sirolimus-eluting grafts were weaker than those observed for paclitaxel-coated grafts in our previous study. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|