External beam radiation therapy to prevent postangioplasty dialysis access restenosis

Parikh, Suhrid; Nori, Dattatreyudu; Rogers, David; Charytan, Chaim; Osian, Adrian; Al-Saloum, Morghe; Cavallo, Giulio

doi:10.1016/s1522-1865(98)00017-1

Cited by 20 publications

(11 citation statements)

References 26 publications

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“…outflow. External beam radiation has been tried, but in small series of patients this was unable to reduce the likelihood of repeat restenosis (61).…”

Section: Future Directionsmentioning

confidence: 99%

Catheter Interventions for Hemodialysis Fistulas and Grafts

Bittl

2010

JACC: Cardiovascular Interventions

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More than 1 in 1,000 patients in the U.S. has end-stage renal disease, and most patients who require renal-replacement therapy undergo hemodialysis. By the year 2020, more than 750,000 patients are expected to have end-stage renal disease, and over 500,000 will require hemodialysis. The greatest limitation of hemodialysis is the finite durability of hemodialysis accesses, which on average remain patent for <3 years but are the lifeline for hemodialysis patients. Catheter-based interventions are successful in restoring flow in more than 80% of hemodialysis accesses that undergo thrombosis and have replaced surgical revision as the treatment of choice for failing or thrombosed accesses. Catheter-based interventions have improved the quality of life for hemodialysis patients by reducing the need for temporary hemodialysis catheters and have prolonged total survival time by preserving existing access sites and by saving venous segments for future access creation. This review discusses the pathophysiology of dialysis access failure, presents the success rates of catheter-based treatments, and illustrates the interventional approaches for treating failing and thrombosed fistulas and grafts.

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“…outflow. External beam radiation has been tried, but in small series of patients this was unable to reduce the likelihood of repeat restenosis (61).…”

Section: Future Directionsmentioning

confidence: 99%

Catheter Interventions for Hemodialysis Fistulas and Grafts

Bittl

2010

JACC: Cardiovascular Interventions

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“…At a clinical level, Parikh et al [92] have performed a phase I study (10 patients) in which two 6-Gy doses of radiation were given post-angioplasty. There were no adverse effects of radiation therapy.…”

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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“…Concurrently to the aforementioned experimental studies, Parikh et al. (61) performed a Phase I safety study (10 patients) in which two 6 Gy doses of external beam gamma radiation were given postangioplasty. There were no adverse effects of this radiation therapy.…”

Section: Rationale For the Use Of Radiation Therapy In Ptfe Dialysis mentioning

confidence: 99%

Radiation Therapy for Dialysis Access Stenosis: Unfulfilled Promise or False Expectations

Ahmed

Roy‐Chaudhury

2012

Seminars in Dialysis

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Hemodialysis vascular access dysfunction is a major cause of morbidity and hospitalization in the hemodialysis population at a cost of well over $1 billion per annum. Venous stenosis (due to venous neointimal hyperplasia [VNH]) is the most common cause of polytetrafluroethylene PTFE) dialysis access graft and arteriovenous fistula (AVF) failure. Despite the magnitude of the clinical problem, however, there are currently no effective therapies for this condition. We and others have previously demonstrated that VNH in PTFE dialysis grafts and AVF is composed of smooth muscle cells/myofibroblasts, endothelial cells within neointimal microvessels, and peri-graft macrophages. Radiation therapy blocks the proliferation and activation of all these cell types. The current review will dissect out the available in vitro, experimental, and clinical data on the use of radiation therapy for vascular stenosis in general, and for dialysis access dysfunction in particular. It is important to try and identify whether there is still a role for radiation therapy in this specific clinical setting. We believe that this is a critically important question to answer in view of the huge unmet clinical need that is currently associated with hemodialysis vascular access dysfunction.

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External beam radiation therapy to prevent postangioplasty dialysis access restenosis

Cited by 20 publications

References 26 publications

Catheter Interventions for Hemodialysis Fistulas and Grafts

Catheter Interventions for Hemodialysis Fistulas and Grafts

Hemodialysis Vascular Access Dysfunction: From Pathophysiology to Novel Therapies

Radiation Therapy for Dialysis Access Stenosis: Unfulfilled Promise or False Expectations

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