Localized Perivascular Therapeutic Approaches to Inhibit Venous Neointimal Hyperplasia in Arteriovenous Fistula Access for Hemodialysis Use.
Localized Perivascular Therapeutic Approaches to Inhibit Venous Neointimal Hyperplasia in Arteriovenous Fistula Access for Hemodialysis Use.
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DOI：
10.3390/biom12101367
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发表时间：
2022-09-24
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影响因子：
5.5
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中科院分区：
文献类型：
--
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动静脉瘘（AVF）是慢性血液透析首选的血管通路，但高失败率限制了其使用。优化患者围手术期状态和手术技术，以及其他预防原发性AVF衰竭的方法，在降低临床实践中的失败率方面仍然存在不足。AVF衰竭的主要原因之一是新生内膜增生（NIH），这一过程是炎症、缺氧和血管组织血流动力学剪切应力协同作用的结果。虽然有几种系统疗法旨在抑制NIH，但没有一种显示出对这一目标的明显益处。局部治疗方法可以通过为成熟瘘管提供直接的结构和功能支持，以及提供更高剂量的药物，同时避免与全身治疗药物相关的不良反应，从而提高AVF成熟的速度。新型材料，如聚合物支架和纳米颗粒，使不同血管周围治疗的发展成为可能，如支持机械装置、靶向药物输送和基于细胞的治疗。在这篇综述中，我们总结了各种血管周围治疗方法，其有效性的现有数据，以及针对NIH的局部治疗在AVF血液透析使用中的前景。重点：大多数全身治疗不能改善AVF通畅的结果；因此，局部治疗方法可能是有益的。当地提供的药物和医疗器械可以通过提供生物和机械支持来改善AVF通畅的结果。基于细胞的治疗已经显示出抑制NIH的希望，通过提供更广泛的生物活性物质阵列来响应AVF微环境中的生化变化。
An arteriovenous fistula (AVF) is the preferred vascular access for chronic hemodialysis, but high failure rates restrict its use. Optimizing patients’ perioperative status and the surgical technique, among other methods for preventing primary AVF failure, continue to fall short in lowering failure rates in clinical practice. One of the predominant causes of AVF failure is neointimal hyperplasia (NIH), a process that results from the synergistic effects of inflammation, hypoxia, and hemodynamic shear stress on vascular tissue. Although several systemic therapies have aimed at suppressing NIH, none has shown a clear benefit towards this goal. Localized therapeutic approaches may improve rates of AVF maturation by providing direct structural and functional support to the maturating fistula, as well as by delivering higher doses of pharmacologic agents while avoiding the adverse effects associated with systemic administration of therapeutic agents. Novel materials—such as polymeric scaffolds and nanoparticles—have enabled the development of different perivascular therapies, such as supportive mechanical devices, targeted drug delivery, and cell-based therapeutics. In this review, we summarize various perivascular therapeutic approaches, available data on their effectiveness, and the outlook for localized therapies targeting NIH in the setting of AVF for hemodialysis use. Highlights: Most systemic therapies do not improve AVF patency outcomes; therefore, localized therapeutic approaches may be beneficial. Locally delivered drugs and medical devices may improve AVF patency outcomes by providing biological and mechanical support. Cell-based therapies have shown promise in suppressing NIH by delivering a more extensive array of bioactive substances in response to the biochemical changes in the AVF microenvironment.
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