From Basic Biology to Randomized Clinical Trial: The Beta Radiation for ArterioVenous Graft Outflow Stenosis (BRAVO II)

Roy‐Chaudhury, Prabir; Arnold, Perry; Seigel, Jeff; Misra, Sanjay

doi:10.1111/sdi.12000

Cited by 11 publications

(7 citation statements)

References 31 publications

(25 reference statements)

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“…Waksman et al treated 18 grafts with restenosis with 11 sites remaining patent at 44 weeks [218]. The BRAVO 2 trial aimed to randomize patients into brachytherapy or sham treatment after the promising results of the BRAVO pilot, but this trial was halted preliminarily [219, 220]. …”

Section: Future Approaches To Treatmentmentioning

confidence: 99%

Future research directions to improve fistula maturation and reduce access failure

Patel

Hänisch

et al. 2016

Seminars in Vascular Surgery

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With the increasing prevalence of end stage renal disease there is a growing need for hemodialysis. Arteriovenous fistulae (AVF) are the preferred type of vascular access for hemodialysis but maturation and failure continue to present significant barriers to successful fistula use. AVF maturation integrates outward remodeling with vessel wall thickening in response to drastic hemodynamic changes, in the setting of uremia, systemic inflammation, oxidative stress and preexistent vascular pathology. AVF can fail due to both failure to mature adequately to support hemodialysis, as well as development of neointimal hyperplasia (NIH) that narrows the AVF lumen, typically near the fistula anastomosis. Failure due to NIH involves vascular cell activation and migration and extracellular matrix remodeling with complex interactions of growth factors, adhesion molecules, inflammatory mediators, and chemokines, all of which result in maladaptive remodeling. Different strategies have been proposed to prevent and treat AVF failure, based on current understanding of the modes and pathology of access failure; these approaches range from appropriate patient selection and use of alternative surgical strategies for fistula creation, to the use of novel interventional techniques or drugs to treat failing fistulae. Effective treatments to prevent or treat AVF failure requires a multidisciplinary approach involving nephrologists, vascular surgeons and interventional radiologists, allowing careful patient selection and the use of tailored systemic or localized interventions to improve patient-specific outcomes. This review provides contemporary information on the underlying mechanisms of AVF maturation and failure and discusses the broad spectrum of options that can be tailored for specific therapy.

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Section: Future Approaches To Treatmentmentioning

confidence: 99%

Future research directions to improve fistula maturation and reduce access failure

Patel

Hänisch

et al. 2016

Seminars in Vascular Surgery

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“…Brachytherapy applied to areas of angioplasty is potentially promising. A randomized study was halted prematurely due to financial issues and although initial results were no different to POBA, long-term follow-up was not possible (16). Perivascular delivery of drugs to modulate development of intimal hyperplasia is also a future area of study.…”

Section: Other Devicesmentioning

confidence: 99%

Balloon Angioplasty for Low-Flow Access

Rajan

2015

J Vasc Access

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The common mechanism for low access flow is intimal hyperplasia leading to stenosis within the access circuit. Balloon angioplasty (percutaneous transluminal angioplasty, PTA) remains the mainstay of treatment despite multiple technologies introduced in the past. New technologies continue to be introduced in an effort to improve on outcomes of angioplasty. This article briefly reviews the use of and outcomes of PTA, technologies, past, present and future as well as some of the questions that remain unanswered with PTA.

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“…A 3-month primary patency rate of 51.7% was achieved in the radiation group, which did not significantly differ from 50% primary patency in the placebo group (p=1.00). Despite the disappointing results, the authors of the study believe that there may still be potentials in endovascular brachytherapy in the setting of dialysis vascular access stenosis when combined with other anti-stenotic means such as local drug, cell, or gene therapy (45).…”

Section: The Combat Against Restenosismentioning

confidence: 99%

The Eternal Tale of Dialysis Access Vessels and Restenosis: Are Drug-Eluting Balloons the Solution?

Portugaller¹,

Kalmár²,

Deutschmann³

2014

J Vasc Access

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In dialysis access fistulas and grafts, percutaneous transluminal angioplasty (PTA) is frequently followed by restenosis development, which results in repeated periodical re-interventions. The technique of drug-eluting balloon (DEB) angioplasty has shown promising results in the treatment of femoropopliteal arteriosclerotic lesions. In contrast to arteriosclerotic arteries, dialysis access vessels host unfavorable hemodynamics due to the direct conduction of high-pressure fluid into a low-pressure system. Hence, the beneficial effect of DEB angioplasty may be limited in this system. However, a first prospective randomized trial on 40 patients with arteriovenous fistula or graft stenoses exhibited a significantly higher 6-month primary patency of the treated lesions after DEB angioplasty than after uncoated balloon angioplasty. Despite such a positive reference, general recommendations regarding the value of DEBs in dialysis access vessels cannot be considered as serious unless large randomized controlled trials have been performed.

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From Basic Biology to Randomized Clinical Trial: The Beta Radiation for ArterioVenous Graft Outflow Stenosis (BRAVO II)

Cited by 11 publications

References 31 publications

Future research directions to improve fistula maturation and reduce access failure

Future research directions to improve fistula maturation and reduce access failure

Balloon Angioplasty for Low-Flow Access

The Eternal Tale of Dialysis Access Vessels and Restenosis: Are Drug-Eluting Balloons the Solution?

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