Photochemically Aided Arteriovenous Fistula Creation to Accelerate Fistula Maturation

• Published in: International journal of molecular sciences Vol. 24; no. 8; p. 7571
• Main Authors: He, Yong, Anderson, Blake, Hu, Qiongyao, Hayes, R B, Huff, Kenji, Isaacson, Jim, Warner, Kevin S, Hauser, Hank, Greenberg, Myles, Chandra, Venita, Kauser, Katalin, Berceli, Scott A
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 01.04.2023; MDPI
• Subjects: 10-8-10 Dimer; Animals; Arteriovenous Fistula - pathology; arteriovenous fistula maturation; Arteriovenous Shunt, Surgical; Dilatation; drug-coated balloon; Fistula, Arteriovenous; hemodialysis vascular access; Humans; natural vascular scaffolding; Proteins; Renal Dialysis; Sheep; Treatment Outcome; Veins - pathology; venous angioplasty; arteriovenous fistula maturation; photochemical treatment; natural vascular scaffolding; 10-8-10 Dimer; photoactivated linking; hemodialysis vascular access; drug-coated balloon; venous angioplasty; outward vascular remodeling; extracellular matrix
• ISSN: 1422-0067; 1661-6596; 1422-0067
• DOI: 10.3390/ijms24087571

Rates of arteriovenous fistula maturation failure are still high, especially when suboptimal size veins are used. During successful maturation, the vein undergoes lumen dilatation and medial thickening, adapting to the increased hemodynamic forces. The vascular extracellular matrix plays an important role in regulating these adaptive changes and may be a target for promoting fistula maturation. In this study, we tested whether a device-enabled photochemical treatment of the vein prior to fistula creation facilitates maturation. Sheep cephalic veins were treated using a balloon catheter coated by a photoactivatable molecule (10-8-10 Dimer) and carrying an internal light fiber. As a result of the photochemical reaction, new covalent bonds were created during light activation among oxidizable amino acids of the vein wall matrix proteins. The treated vein lumen diameter and media area became significantly larger than the contralateral control fistula vein at 1 week ( = 0.035 and = 0.034, respectively). There was also a higher percentage of proliferating smooth muscle cells in the treated veins than in the control veins ( = 0.029), without noticeable intimal hyperplasia. To prepare for the clinical testing of this treatment, we performed balloon over-dilatation of isolated human veins and found that veins can tolerate up to 66% overstretch without notable histological damage.