CorMatrix Wrapped Around the Adventitia of the Arteriovenous Fistula Outflow Vein Attenuates Venous Neointimal Hyperplasia

Abstract

Venous neointimal hyperplasia (VNH) at the outflow vein of hemodialysis AVF is a major factor contributing to failure. CorMatrix is an extracellular matrix that has been used in cardiovascular procedures primarily as scaffolding during surgery. In the present study, we sought to determine whether CorMatrix wrapped around the outflow vein of arteriovenous fistula (AVF) at the time of creation could reduce VNH. In mice, the carotid artery to the ipsilateral jugular vein was connected to create an AVF, and CorMatrix scaffold was wrapped around the outflow vein compared to control mice that received no scaffolding. Immunohistochemistry, Western blot, and qRT-PCR were performed on the outflow vein at 7 and 21 days after AVF creation. In outflow veins treated with CorMatrix, there was an increase in the mean lumen vessel area with a decrease in the ratio of neointima area/media + adventitia area (P < 0.05). Furthermore, there was a significant increase in apoptosis, with a reduction in cell density and proliferation in the outflow veins treated with CorMatrix compared to controls (P < 0.05). Immunohistochemical analysis revealed a significant reduction in fibroblasts, myofibroblasts, macrophages, and leukocytes with a reduction in Tnf-α gene expression (P < 0.05). In conclusion, outflow veins treated with CorMatrix have reduced VNH.

Therapeutic Effect of Adipose Derived Mesenchymal Stem Cell Transplantation in Reducing Restenosis in a Murine Angioplasty Model

“…In experimental animal models and clinical samples removed from patients with malfunctioning hemodialysis AVF, there is increased expression of proinflammatory cytokines, including IL-1b and TNF-a, accompanied by increased staining of CD68 (1) cells. 4,20,30 These observations indicate proinflammatory cues maybe responsible for stenosis formation after PTA. It is well known that AMSCs have anti-inflammatory properties and they may help to reduce venous stenosis formation after PTA.…”

Multicenter European real-world utilization of VasQ anastomotic external support device for arteriovenous fistulae

“…The vein undergoes hypertrophic remodeling including neointimal hyperplasia of this segment to return wall tension to nominal levels. Providing structural reinforcement with an external support device has demonstrated the ability to control the degree of localized hypertrophic response and smooth muscle density in animal studies 12,13 . In humans, the application of external support for vein bypass grafts has demonstrated a reduction in intimal hyperplasia over long-term followup 14 .…”

Atorvastatin Reduces In Vivo Fibrin Deposition and Macrophage Accumulation, and Improves Primary Patency Duration and Maturation of Murine Arteriovenous Fistula

“…12,13 However, antiplatelet-agent administration with either clopidogrel or ticlopidine, while improving AVF patency, does not increase the proportion of fistulas that are suitable for dialysis. 11,14 In addition, although experimental studies demonstrate the importance of the inflammatory response in the pathogenesis of AVF failure, [15][16][17][18][19][20][21] to date clinical anti-inflammatory therapies have not yet increased primary AVF maturation rates. 11,22,23 Therefore, therapies likely to provide durable AVF maturation will likely need to promote both favorable outward remodeling and reduced thrombosis rates.…”