Brachytherapy in the prevention of re-stenosis after percutaneous transluminal angioplasty (PTA) for central venous stenosis (CVS).
ASN 30th Annual Meeting, San Antonio
J Am Soc Nephrol (Sep) 8:175A 1997
As we never tire of telling each other, vascular access stenosis remains the most difficult and persistent clinical problem for the person on hemodialysis. As we use more central catheters, we see more central vein stenosis, and so it goes. Vascular problems seem only to proliferate as dialysis technology advances, and little is new in access preservation beyond more quickly and easily available methods of angioplasty or thrombectomy.
Choi et al. present in this abstract what may be a very important new concept: prophylactic endovascular irradiation following angioplasty. A good deal of animal work and a few clinical studies of either endovascular (1) or percutaneous [2] irradiation of angioplastied and stented femoral arteries have been reported, with apparent improvement in post-irradiation patency. The present authors have applied this approach to the brachiocephalic vein, applying endovascular irradiation with Ir192 after angioplasty and stenting. They report three patients, two of whom had no evidence of restenosis after 6 months; the third had stenosis in another segment of the vein.
Comment: This is admittedly a very small group of patients, and a relatively short followup, but nevertheless is extremely encouraging, and larger studies are eagerly to be awaited. One wonders if prophylactic irradiation might not be useful not only for stented central veins, but also for venous stenoses associated with PTFE grafts, where neointimal hyperplasia also seems to be the principal problem. (Robert H. Barth, M.D., VA Medical Center, Brooklyn, NY)
References
[1] Schopohl B, Leirmann D, Pohlit LJ et al. 192IR endovascular brachytherapy for avoidance of intimal hyperplasia after percutaneous transluminal angioplasty and stent implantation in peripheral vessels: 6 years of experience. Int J Radiat Oncol Biol Phys 1996; 36:835-840.
[2] Steidle B. [Preventive percutaneous radiotherapy for avoiding hyperplasia of the intima following angioplasty together with stent implantation]. Strahlenther Onkol. 1994; 170: 151-154. (in German).
To go back use the BACK button on your browser. Otherwise click on the desired link to this article below:
ASN 30th Annual Meeting, San Antonio
Basic hemodialysis : Vascular Access: graft/fistula