Biomaterial-Based Approaches to Address Vein Graft and Hemodialysis Access Failures.
Biomaterial-Based Approaches to Address Vein Graft and Hemodialysis Access Failures.
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DOI：
10.1002/marc.201600412
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发表时间：
2016-12
影响因子：
4.6
通讯作者：
Sung, Hak-Joon
中科院分区：
文献类型：
--
作者：
Boire, Timothy C.;Balikov, Daniel A.;Lee, Yunki;Guth, Christy M.;Cheung-Flynn, Joyce;Sung, Hak-Joon
用作心脏搭桥术中的移植物或血液透析中的接入点的静脉表现出很高的失败率，从而导致患者显着的发病率和死亡率。纠正这些失败所需的介入或修复手术效果有限，而且费用高昂，特别是对于美国医疗保险和医疗补助服务中心而言。导致失败的静脉狭窄或闭塞主要是新生内膜增生的结果。全身疗法几乎没有取得长期成功，这表明需要更局部、持续、基于生物材料的解决方案。大量研究已经证明外部支架能够减少新内膜增生。然而，迄今为止，动物模型的成功结果尚未转化为临床，目前美国还没有批准使用外部支架来预防静脉移植或血液透析通路失败。本综述讨论了基于生物材料的外部支架该领域的当前进展、设计考虑因素和未来前景。更多迭代调节生物材料和生物材料-药物方法的比较研究对于解决与外部支架应用于动静脉环境相关的机械知识差距至关重要。解决这些差距最终将带来更可行的解决方案，防止静脉移植和血液透析通路失败。外部支架为防止静脉移植和血液透析通路失败提供了一种有前景的方法。其执行此操作的能力取决于所选的材料和支架设计。物理化学特性（例如化学、分子量）和支架几何形状（例如直径、长度、孔径和互连性）决定支架特性（例如生物降解时间、机械特性），并最终决定其引起的生物反应。
Veins used as grafts in heart bypass or as access points in hemodialysis exhibit high failure rates, thereby causing significant morbidity and mortality for patients. Interventional or revisional surgeries required to correct these failures have been met with limited success and exorbitant costs, particularly for the US Centers for Medicare & Medicaid Services. Vein stenosis or occlusion leading to failure is primarily the result of neointimal hyperplasia. Systemic therapies have achieved little long-term success, indicating the need for more localized, sustained, biomaterial-based solutions. Numerous studies have demonstrated the ability of external stents to reduce neointimal hyperplasia. However, successful results from animal models have failed to translate to the clinic thus far, and no external stent is currently approved for use in the US to prevent vein graft or hemodialysis access failures. This review discusses current progress in the field, design considerations, and future perspectives for biomaterial-based external stents. More comparative studies iteratively modulating biomaterial and biomaterial-drug approaches are critical in addressing mechanistic knowledge gaps associated with external stent application to the arteriovenous environment. Addressing these gaps will ultimately lead to more viable solutions that prevent vein graft and hemodialysis access failures. External stents provide a promising means to prevent vein graft and hemodialysis access failures. Its ability to do this depends on the material and scaffold design chosen. Physicochemical properties (e.g. chemistry, molecular weight) and scaffold geometry (e.g. diameter, length, pore size and interconnectivity) govern the stent properties (e.g. biodegradation time, mechanical properties) and, ultimately, the biological response that it elicits.
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影响因子：
9.7
作者：
Boire TC;Gupta MK;Zachman AL;Lee SH;Balikov DA;Kim K;Bellan LM;Sung HJ
通讯作者：
Sung HJ
影响因子：
4.3
作者：
Byrom, Michael J.;Bannon, Paul G.;Ng, Martin K. C.
通讯作者：
Ng, Martin K. C.
影响因子：
158.5
作者：
CHESEBRO, JH;FUSTER, V;FRYE, RL
通讯作者：
FRYE, RL
可扩展的外部支撑装置可改善 CABG 后隐静脉移植物的通畅性。
影响因子：
1.6
作者：
Ben-Gal Y;Taggart DP;Williams MR;Orion E;Uretzky G;Shofti R;Banai S;Yosef L;Bolotin G
通讯作者：
Bolotin G
影响因子：
4
作者：
Bai Feng;Zhang Jinkang;Dong Xin
通讯作者：
Dong Xin