External-beam radiation therapy for improved dialysis access patency: feasibility and early safety

Radiat Res. 2001 Jul;156(1):53-60. doi: 10.1667/0033-7587(2001)156[0053:ebrtfi]2.0.co;2.

Abstract

Rectenwald, J. E., Pretus, H. A., Seeger, J. M., Huber, T. S., Mendenhall, N. P., Zlotecki, R. A., Palta, J. R., Li, Z. F., Hook, S. Y., Sarac, T. P., Welborn, M. B., Klingman, N. V., Abouhamze, Z. S. and Ozaki, C. K. External-Beam Radiation Therapy for Improved Dialysis Access Patency: Feasibility and Early Safety. Radiat. Res. 156, 53-60 (2001).Prosthetic dialysis access grafts fail secondary to neointimal hyperplasia at the venous anastomosis. We hypothesized that postoperative single-fraction external-beam radiation therapy to the venous anastomosis of hemodialysis grafts can be used safely in an effort to improve access patency. Dogs (n = 8) underwent placement of expanded polytetrafluoroethylene grafts from the right carotid artery to the left jugular vein. Five dogs received single-fraction external-beam photon irradiation (8 Gy) to the venous anastomosis after surgery. Controls were not irradiated. Shunt angiograms were completed 3 and 6 months postoperatively. Anastomoses, mid-graft, and the surrounding tissues were analyzed. Immunohistochemistry for smooth muscle cell alpha-actin, proliferating cellular nuclear antigen (PCNA), and apoptosis was performed. Incisions healed well, though all animals developed wound seromas. One control suffered graft thrombosis 4 months postoperatively. Angiography/histology confirmed severe neointimal hyperplasia at the venous anastomosis. The remaining seven dogs developed similar amounts of neointimal hyperplasia. PCNA studies showed no accelerated fibroproliferative response at irradiated anastomoses compared to controls. Skin incisions and soft tissues over irradiated anastomoses revealed no radiation-induced changes or increase in apoptosis. Thus we conclude that postoperative single-fraction external-beam irradiation of the venous anastomosis of a prosthetic arteriovenous graft that mimics the situation in humans is feasible and safe with regard to early wound healing.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Actins / metabolism
  • Animals
  • Apoptosis / radiation effects
  • Arteriovenous Shunt, Surgical* / adverse effects
  • Arteriovenous Shunt, Surgical* / instrumentation
  • Blood Vessel Prosthesis* / adverse effects
  • Carotid Arteries / metabolism
  • Carotid Arteries / radiation effects
  • Dogs
  • Feasibility Studies
  • Female
  • Graft Occlusion, Vascular / etiology
  • Graft Occlusion, Vascular / pathology
  • Graft Occlusion, Vascular / prevention & control*
  • Immunohistochemistry
  • Jugular Veins / metabolism
  • Jugular Veins / radiation effects
  • Polytetrafluoroethylene
  • Proliferating Cell Nuclear Antigen / metabolism
  • Renal Dialysis / methods
  • Skin / radiation effects
  • Tunica Intima / metabolism
  • Tunica Intima / pathology
  • Tunica Intima / radiation effects*
  • Vascular Patency / radiation effects*
  • Wound Healing / radiation effects

Substances

  • Actins
  • Proliferating Cell Nuclear Antigen
  • Polytetrafluoroethylene