BRAVO I: A pilot study of vascular brachytherapy in polytetrafluoroethylene dialysis access grafts
BRAVO I: A pilot study of vascular brachytherapy in polytetrafluoroethylene dialysis access grafts
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DOI：
10.1038/sj.ki.5001869
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发表时间：
2006-12-01
影响因子：
19.6
通讯作者：
Roy-Chaudhury, P.
中科院分区：
文献类型：
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作者：
Misra, S.;Bonan, R.;Roy-Chaudhury, P.
聚四氟乙烯透析通道移植物狭窄和血栓形成导致的血液透析血管通路功能障碍是一个巨大的临床问题，目前尚无长期持久的治疗方法。血管近距离治疗已成功地用于预防血管成形术和支架置入后的冠状动脉再狭窄。β辐射治疗动静脉移植物流出I研究是一项血管近距离治疗具有未愈合但功能不全移植物的血液透析患者的初步研究。25名患者在血管成形术后随机接受放射治疗（单剂量18.4 Gy）或假放射治疗。该研究的主要疗效终点是6个月时靶病变原发通畅。主要的安全终点是死亡、移植物急诊手术、静脉破裂或动脉瘤形成的综合结果。与对照组的0% （P = 0.015）相比，42%的放射移植物在6个月时达到了目标病变初级通畅终点（P = 0.015），但这并没有转化为6个月或12个月时继发性通畅的改善。发现放射治疗在血液透析血管通路功能障碍的情况下是安全的。我们的研究结果表明，血管近距离治疗是一种值得进一步研究的干预措施，适用于非血栓性透析通道移植物。
Hemodialysis vascular access dysfunction owing to stenosis and thrombosis in polytetrafluoroethylene dialysis access grafts is a huge clinical problem for which there are currently no long lasting durable therapies. Vascular brachytherapy has been used successfully for the prevention of coronary restenosis following angioplasty and stent placement. The Beta Radiation for Treatment of Arterial-Venous Graft Outflow I study was a pilot study of vascular brachytherapy in hemodialysis patients with patent but dysfunctional grafts. Twenty-five patients were randomized to receive either radiation therapy (a single dose of 18.4 Gy) or sham radiation, following angioplasty. The primary efficacy end point of the study was target lesion primary patency at 6 months. The primary safety end point was a composite of death, emergency surgery on the graft, venous rupture, or aneurysm formation. Forty-two percent of the radiated grafts achieved the target lesion primary patency end point at 6 months as compared to 0% of the control group (P = 0.015), but this did not translate into an improvement in secondary patency at either 6 or 12 months. Radiation therapy was found to be safe in the setting of hemodialysis vascular access dysfunction. Our results suggest that vascular brachytherapy is an intervention that is worthy of further examination in the setting of non-thrombosed dialysis access grafts.