Perivascular paclitaxel wraps block arteriovenous graft stenosis in a pig model

Kelly, Burnett S.; Melhem, Murad; Zhang, Jianhua; Kasting, Gerald B.; Li, Jinsong; Krishnamoorthy, Mahesh; Heffelfinger, Sue C.; Rudich, Steven; Desai, Pankaj B.; Roy‐Chaudhury, Prabir

doi:10.1093/ndt/gfl250

Cited by 66 publications

(52 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Perivascular delivery of antiproliferative drugs permits achieving high local drug levels while avoiding systemic toxicity. Two studies using a porcine arteriovenous graft model demonstrated reduction of neointimal hyperplasia and graft stenosis by perivascular delivery of paclitaxel (95,96). No human studies have been reported to date using local drug delivery systems to prevent graft failure.…”

Section: Pharmacologic Interventions To Reduce Graft Thrombosismentioning

confidence: 99%

Current Management of Vascular Access

Allon¹

2007

Clinical Journal of the American Society of Nephrology

245

231

View full text Add to dashboard Cite

Optimizing vascular access outcomes remains an ongoing challenge for clinical nephrologists. All other things being equal, fistulas are preferred over grafts, and grafts are preferred over catheters. Mature fistulas have better longevity and require fewer interventions, as compared with mature grafts. The major hurdle to increasing fistula use is the high rate of failure to mature of newly created fistulas. There is a desperate need for enhanced understanding of the mechanisms of failure to mature and the optimal type and timing of interventions to promote maturity. Grafts are prone to frequent stenosis and thrombosis. Surveillance for graft stenosis with preemptive angioplasty may reduce graft thrombosis, but recent randomized clinical trials have questioned the efficacy of this approach. Graft stenosis results from aggressive neointimal hyperplasia, and pharmacologic approaches to slowing this process are being investigated in clinical trials. Catheters are prone to frequent thrombosis and infection. The optimal management of catheter-related bacteremia is a subject of ongoing debate. Prophylaxis of catheter-related bacteremia continues to generate important clinical research. Close collaboration among nephrologists, surgeons, radiologists, and the dialysis staff is required to optimize vascular access outcomes and can be expedited by having a dedicated access coordinator to streamline the process. The goal of this review is to provide an update on the current status of vascular access management.

show abstract

Section: Pharmacologic Interventions To Reduce Graft Thrombosismentioning

confidence: 99%

Current Management of Vascular Access

Allon¹

2007

Clinical Journal of the American Society of Nephrology

245

231

View full text Add to dashboard Cite

show abstract

“…Biodegradable polymer wraps have been used to deliver antiproliferative drugs to the perivascular region of hemodialysis access vessels in both animal models (70) and patients. In animal studies, perivascular wraps that elute paclitaxel were beneficial in inhibiting neointimal hyperplasia in AVGs (71). The paclitaxel wrap combination (Vascular Wrap; Angiotech) was shown to be beneficial in preventing neointimal hyperplasia in peripheral arterial bypass grafts in a European cohort.…”

Section: Perivascular Approachesmentioning

confidence: 99%

Novel Therapies for Hemodialysis Vascular Access Dysfunction

Terry

Dember

2013

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

SummaryHemodialysis vascular access dysfunction is a major source of morbidity for patients with ESRD. Development of effective approaches to prevent and treat vascular access failure requires an understanding of the underlying mechanisms, suitable models for preclinical testing, systems for targeted delivery of interventions to maximize efficacy and minimize toxicity, and rigorous clinical trials that use appropriate outcome measures. This article reviews the substantial progress and ongoing challenges in developing novel treatments for arteriovenous vascular access failure and focuses on localized rather than systemic interventions.

show abstract

“…However, the arteries had incomplete healing of the endothelium, increased numbers of inflammatory cells, and extensive fibrin and platelet deposition [233,[235][236][237]. In pigs, paclitaxel given locally via an arterial stent or administered locally to vein grafts or arteriovenous shunts resulted in reduced neointimal formation in the short term [98,233,238], but this benefit was not seen in longer term experiments due to "catch-up" neointimal formation [98,233]. Other means of delivering paclitaxel have been investigated, including encapsulating it in multilayered "nanoburrs" that have hooks on their surface that bind to specific peptides on exposed surfaces.…”

Section: Cytostatic and Immunosuppressivementioning

confidence: 99%

Targeted Treatments for Restenosis and Vein Graft Disease

Thomas

2012

ISRN Vascular Medicine

View full text Add to dashboard Cite

Surgery to restore blood flow in arteries blocked by atherosclerotic plaque is a common treatment in cardiovascular disease. Longterm complications of surgical treatment are vein graft disease and restenosis, a renarrowing of the blood vessel after bypass or removal of the culprit atherosclerotic plaque. Attempts to prevent or treat these complications by systemic pharmacological approaches have been largely unsuccessful in the clinic. This has led to an interest in developing targeted or locally delivered strategies. This paper discusses many of the various site-delivered therapies that are under examination as potential antirestenotic and antivein graft disease agents (including antithrombotic, antiproliferative, and anti-inflammatory agents) and why many therapies developed in animal models fail in clinical trials. Techniques of targeted delivery (including stents, "magic bullets," and adventitial delivery) and delivery systems (including nanoparticles and the use of gene therapy) are also discussed.

show abstract

Perivascular paclitaxel wraps block arteriovenous graft stenosis in a pig model

Cited by 66 publications

References 27 publications

Current Management of Vascular Access

Current Management of Vascular Access

Novel Therapies for Hemodialysis Vascular Access Dysfunction

Targeted Treatments for Restenosis and Vein Graft Disease

Contact Info

Product

Resources

About