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Photochemical Tissue Passivation Attenuates Intimal Hyperplasia in an Arteriovenous Fistula Model
Robert N. Goldstone, M.D., Michael C. McCormack, MBA, Rachel L. Goldstein, DO, Mark A. Randolph, MAS, Robert W. Redmond, PhD, William G. Austen, Jr., MD.
Massachusetts General Hospital, Boston, MA, USA.

PURPOSE: Although arteriovenous fistulae (AVF) are the gold standard for vascular access, their effectiveness is limited by poor patency; 40-70% of fistulae fail within one year due to intimal hyperplasia (IH). Venous stretch injury from exposure to arterial pressure induces IH. Photochemical tissue passivation (PTP) is a novel technology that cross-links adventitial collagen, strengthening the vein and decreasing its compliance to resemble that of an artery. We hypothesize that decreasing vein compliance will protect the vein against stretch injury and reduce IH.
METHODS: AVF were created between the femoral artery and superficial epigastric vein in Sprague-Dawley rats. PTP was performed immediately prior to performing vessel anastomosis. AVF were harvested after 4 weeks and each specimen was divided into 3 regions: the venous juxta-anastomotic segment, proximal vein, and distal vein. Venous diameter was measured at the time of the initial procedure and at harvest. Intimal area was measured for each segment.
RESULTS: All AVF remained patent. Dilatation of the venous segments of AVF at initial placement/one month were 27±7%/45±28% for PTP-treated vessels and 76±17%/112±33% for controls (p=0.02). Intimal area was 0.160±0.084mm2 and 0.028±0.023mm2 for control and PTP-treated juxta-anastomotic segments, respectively (p=0.02). Total intimal area for control and PTP-treated AVF was 0.266±0.099mm2 and 0.094±0.051mm2, respectively (p=0.04).
CONCLUSION: PTP treatment effectively reduces juxta-anastomotic and total IH by improving vein elasticity to attenuate venous stretch injury.


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