External Beam Irradiation as an Adjunctive Treatment in Failing Dialysis Shunts

Cohen, Gary; Freeman, Hank; Ringold, Michael A.; Putnam, Samuel; Ball, David S.; Silverman, Craig L.; Schulman, G.

doi:10.1016/s1051-0443(07)61424-9

Cited by 25 publications

(9 citation statements)

References 13 publications

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“…Moreover, there are no randomized studies that could confirm their superiority. Endovascular brachytherapy and external radiation are additional interventional methods that have not yet been able to be proven to be superior and are thus not used in the clinical routine [69]. With the goal of preventing neointimal hyperplasia, brachytherapy was examined in a pilot study including 25 patients [15].…”

Section: Stenosis Of the Vascular Access Veinmentioning

confidence: 99%

Diagnosis and Treatment of Insufficient Dialysis Vascular Access

Kamper

Faizy²,

Haage³

2015

Fortschr Röntgenstr

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A wide variety of diagnostic and minimally invasive modalities is currently available to radiologists for providing sufficient medical care for dialysis patients. In addition to clinical examination, ultrasound is the first line imaging method in suspected dialysis vascular access dysfunction. The percutaneous approach is the primarily recommended therapeutic option in many cases. This article reviews the current diagnostic and therapeutic methods in dialysis vascular access insufficiency. Key Points: ??Vascular access dysfunction is often elicited by stenosed vessels, which are regularly associated with concomitant thrombosis. ??Stenoses are commonly observed in the anastomosis, vascular access vein and also in the central venous system. ??Beside the clinical examination, sonography is the diagnostic method of first choice. ??Percutaneous balloon dilatation frequently is the first treatment option. Citation Format: ??Kamper L, Faizy TD, Haage P. Diagnosis and Treatment of Insufficient Dialysis Vascular Access. Fortschr R?ntgenstr 2015; 187: 360???371

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Section: Stenosis Of the Vascular Access Veinmentioning

confidence: 99%

Diagnosis and Treatment of Insufficient Dialysis Vascular Access

Kamper

Faizy²,

Haage³

2015

Fortschr Röntgenstr

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“…There were no adverse effects of radiation therapy. Cohen et al [93] have conducted the only randomized study of external beam radiation in dialysis access grafts and fistulae. They were not able to demonstrate a benefit from external radiation therapy in this very heterogeneous group of dialysis access, although there was a trend towards better results in the radiation group.…”

Section: Radiation Therapymentioning

confidence: 99%

Hemodialysis Vascular Access Dysfunction: From Pathophysiology to Novel Therapies

Roy‐Chaudhury¹,

Kelly²,

Zhang³

et al. 2003

Blood Purif

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Hemodialysis vascular access dysfunction is a major cause of morbidity and hospitalization in the hemodialysis population at a cost of over USD 1 billion per annum. Most hemodialysis grafts fail due to a venous stenosis (venous neointimal hyperplasia) which then results in thrombosis of the graft. Despite the magnitude of the clinical problem there are currently no effective therapies for this condition. The current review (a) describes the pathogenesis and pathology of venous stenosis in dialysis access grafts and (b) discusses the development and application of novel therapeutic interventions for this difficult clinical problem. Special emphasis is laid on the fact that PTFE dialysis access grafts could be the ideal clinical model for testing out novel local therapies to block neointimal hyperplasia.

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“…Observations on the effect of EBR in animals have been contradictory. 16 -21 In clinical studies, EBR did not prevent restenosis after PTA of hemodialysis fistulas 22 or iliac or femoropopliteal arteries. 23 EBR also had no significant effect on anastomotic intimal hyperplasia in prosthetic arteriovenous fistulas.…”

Section: Discussionmentioning

confidence: 99%

External Beam Radiation to Prevent Restenosis After Superficial Femoral Artery Balloon Angioplasty

et al. 2005

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Background— Femoropopliteal percutaneous transluminal angioplasty (PTA) remains limited by restenosis. Although vascular brachytherapy may be effective in reducing restenosis, external beam radiation would be more practical to administer after PTA. Methods and Results— After femoropopliteal PTA without stent placement, 99 patients were randomly assigned to 0 Gy (placebo; n=24), 7 Gy (n=24), 10.5 Gy (n=26), or 14 Gy (n=25) of external beam radiation of the PTA site (with a 3-cm margin at both extremities) in 1 session 24 hours after PTA. The primary end point was minimum lumen diameter on quantitative angiography 1 year after PTA. One year after PTA, the mean minimum lumen diameter was 1.92, 1.64, 1.92, and 2.91 mm, respectively, for the 0-, 7-, 10.5-, and 14-Gy groups ( P =0.0072 for 0 versus 14 Gy). Mean luminal loss was 1.14, 1.27, 1.08, and 0.14 mm, respectively, for the 4 groups ( P =0.0072 for 0 versus 14 Gy). Restenosis >50% was present in 50%, 65%, 48%, and 25% of patients, respectively, for the 0-, 7-, 10.5-, and 14-Gy groups ( P =0.072). At 18 months, repeated revascularizations were required in 25% of patients in the 0-Gy group versus 12% of patients in the 14-Gy group ( P =0.24). Conclusions— A single session of external beam radiation of 14 Gy of the femoropopliteal angioplasty site significantly reduces restenosis at 1 year.

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External Beam Irradiation as an Adjunctive Treatment in Failing Dialysis Shunts

Cited by 25 publications

References 13 publications

Diagnosis and Treatment of Insufficient Dialysis Vascular Access

Diagnosis and Treatment of Insufficient Dialysis Vascular Access

Hemodialysis Vascular Access Dysfunction: From Pathophysiology to Novel Therapies

External Beam Radiation to Prevent Restenosis After Superficial Femoral Artery Balloon Angioplasty

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