Wojciech Wystrychowski, MD, PhD, Todd N

Slides:

Advertisements

Similar presentations

The Dialysis Patient Access Kidney Transplantation Anne Lally, MD Surgical Director of Kidney Transplantation Hartford Hospital.

Advertisements

Bypass graft to the contralateral internal jugular vein for venous outflow obstruction of a functioning hemodialysis access fistula Jeff L. Myers, MD,

M. Kim, H. Kwon, S. -K. Hong, Y. Han, H. Park, J. Y. Choi, T. -W

Follow-up of renal artery stenosis by duplex ultrasound

Bioengineered vascular access maintains structural integrity in response to arteriovenous flow and repeated needle puncture Bryan W. Tillman, MD, PhD,

Successful lower extremity angioplasty improves brachial artery flow-mediated dilation in patients with peripheral arterial disease Marc Husmann, MD,

Management of perianastomotic stenosis of direct wrist autogenous radial-cephalic arteriovenous accesses for dialysis Bertrand Long, MD, Nicolas Brichart,

Annie Wang, MD, James E. Silberzweig, MD

Karan Garg, MD, Brittny Williams Howell, MD, Stephanie S

Balloon angioplasty versus Viabahn stent graft for treatment of failing or thrombosed prosthetic hemodialysis grafts Thomas Vesely, MD, William DaVanzo,

Neovascularization in acute venous thrombosis

Hernan A. Bazan, MD, Harry Schanzer, MD Journal of Vascular Surgery

Amplatzer vascular plug for occlusion or flow reduction of hemodialysis arteriovenous access Pierre Bourquelot, MD, Lamisse Karam, MD, Alain Raynaud,

Creation and closure of temporary arteriovenous fistulas for venous reconstruction or thrombectomy: Description of technique Richard J. Sanders, M.D.,

Use of the distal radial artery remnant for autogenous radial-cephalic wrist fistula after radial artery harvest for coronary artery bypass grafting

Vascular access in hemodialysis patients older than 80 years

Long-term patency of small-diameter vascular graft made from fibroin, a silk-based biodegradable material Soichiro Enomoto, MD, PhD, Makoto Sumi, MD,

Early infection risk with primary versus staged Hemodialysis Reliable Outflow (HeRO) graft implantation Andrew S. Griffin, MD, Shawn M. Gage, PA-C, Jeffrey.

Recurrent popliteal vein aneurysm

Menno H. Raber, MD, Robbert Meerwaldt, MD, PhD, Rob J. van Det, MD

Lindsey M. Korepta, MD, Jennifer J. Watson, MD, Erin A

Takashi Nakamura, MD, Kotaro Suemitsu, MD, Junichi Nakamura, MD

Ung Bae Jeon, MD, Chang Won Kim, MD, Sung Woon Chung, MD

Stent graft treatment for hemodialysis access aneurysms

Balloon angioplasty versus Viabahn stent graft for treatment of failing or thrombosed prosthetic hemodialysis grafts Thomas Vesely, MD, William DaVanzo,

Brachial versus basilic vein dialysis fistulas: A comparison of maturation and patency rates Kevin Casey, MD, Britt H. Tonnessen, MD, Krishna Mannava,

Multiple aneurysms of the radial artery in a woman with neurofibromatosis type 1 presenting as aneurysm rupture Francesco De Santis, MD, PhD, Giovanni.

Tommaso Lupattelli, MD, Giovanni Nano, MD, Luigi Inglese, MD

Surgical thrombectomy for iliofemoral venous thrombosis revisited

Primary tibial vein aneurysm with recurrent pulmonary emboli

Tumescent anesthesia reduces pain associated with balloon angioplasty of hemodialysis fistulas Wen-Yu V. Haines, MD, Ryan Deets, BS, Ning Lu, BS, John.

Adventitial endothelial implants reduce matrix metalloproteinase-2 expression and increase luminal diameter in porcine arteriovenous grafts Helen M.

“Better” (sometimes) in vascular disease management

Outpatient treatment of arterial inflow stenoses of dysfunctional hemodialysis access fistulas by retrograde venous access puncture and catheterization

Cost analysis of the Hemodialysis Reliable Outflow (HeRO) Graft compared to the tunneled dialysis catheter Julien Al Shakarchi, MBChB, MSc, MRCS, Nicholas.

Internal jugular to axillary vein bypass for subclavian vein thrombosis in the setting of brachial arteriovenous fistula John D. Puskas, MD, Jonathan.

De novo renal artery aneurysm presenting 6 years after transplantation: A complication of recurrent arterial stenosis? Shelby H. Burkey, MD, Miguel A.

Use of the distal radial artery remnant for autogenous radial-cephalic wrist fistula after radial artery harvest for coronary artery bypass grafting

Arteriovenous fistula combined with brachial artery superficialization is effective in patients with a high risk of maturation failure Masaaki Murakami,

Michael D. Sgroi, MD, Madhukar S. Patel, MD, Samuel E

Thrombectomy with temporary arteriovenous fistula: The treatment of choice in acute iliofemoral venous thrombosis G. Plate, M.D., E. Einarsson, M.D.,

SS14. Outcomes Comparison of Chest Wall Arteriovenous Grafts and Lower Extremity Arteriovenous Grafts in Patients With Long-Standing Renal Failure Jie.

Pediatric venous thromboembolism in relation to adults

Follow-up of renal artery stenosis by duplex ultrasound

In-hospital and 30-day outcomes after tibioperoneal interventions in the US Medicare population with critical limb ischemia Todd R. Vogel, MD, MPH, Viktor.

Masson's tumor in the ulnar artery

Flow reduction in high-flow arteriovenous access using intraoperative flow monitoring Juergen Zanow, MD, Karen Petzold, MD, Michael Petzold, MD, Ulf Krueger,

Subclavian steal syndrome from high-output brachiocephalic arteriovenous fistula: A previously undescribed complication of dialysis access W.G. Schenk,

Claus G. Schneider, MD, Karim A

Efficiency of the kidney disease outcomes quality initiative guidelines for preemptive vascular access in an academic setting Traci A. Kimball, MD, Ken.

Early results of percutaneous arteriovenous fistula creation with the Ellipsys Vascular Access System Alexandros Mallios, MD, William C. Jennings, MD,

Nitinol stenting improves primary patency of the superficial femoral artery after percutaneous transluminal angioplasty in hemodialysis patients: A propensity-matched.

Roel H. D. Vaes, MD, Jan H. Tordoir, MD, PhD, Marc R

Criteria for defining significant central vein stenosis with duplex ultrasound Nicos Labropoulos, PhD, DIC, RVT, Marc Borge, MD, Kenneth Pierce, MD, Peter.

Peter Neglén, MD, PhD, Seshadri Raju, MD Journal of Vascular Surgery

Todd R. Vogel, MD, MPH, Robin L. Kruse, PhD

Femoral pseudoaneurysms after percutaneous access

Leptin, pre-existing vascular disease, and increased arteriovenous fistula maturation failure in dialysis patients Jwa-Kyung Kim, MD, Sun Ryoung Choi,

Development of a spontaneously beating vein by cardiomyocyte transplantation in the wall of the inferior vena cava in a rat: A pilot study Wangde Dai,

Prevention of vascular access hand ischemia using the axillary artery as inflow William Jennings, MD, Robert Brown, MD, John Blebea, MD, MBA, Kevin Taubman,

Bypass graft to the contralateral internal jugular vein for venous outflow obstruction of a functioning hemodialysis access fistula Jeff L. Myers, MD,

Linda Le, MD, Ashton Brooks, MBBS, Melissa Donovan, MD, Taylor A

Influence of diabetes and perivascular allogeneic endothelial cell implants on arteriovenous fistula remodeling Michael S. Conte, MD, Helen M. Nugent,

Five-year outcome study of deep vein thrombosis in the lower limbs

A personal experience with factors influencing survival after elective open repair of infrarenal aortic aneurysms Norman R. Hertzer, MD, Edward J. Mascha,

Massive upper gastrointestinal bleeding due to a ruptured superior mesenteric artery aneurysm duodenum fistula Jichun Zhao, MD, PhD Journal of Vascular.

Rebecca Jeanmonod, MD, Chad Lewis, MD Journal of Vascular Surgery

Scott S. Berman, MD, FACS, Andrew T. Gentile, MD

Richard L. McCann, M.D., Raymond Makhoul, M.D., Ralph Damiano, M.D.

Stephen Kolakowski, MD, Matthew J Dougherty, MD, Keith D Calligaro, MD

Presentation transcript:

First human use of an allogeneic tissue-engineered vascular graft for hemodialysis access Wojciech Wystrychowski, MD, PhD, Todd N. McAllister, PhD, Krzysztof Zagalski, MD, Nathalie Dusserre, PhD, Lech Cierpka, MD, PhD, Nicolas L'Heureux, PhD Journal of Vascular Surgery Volume 60, Issue 5, Pages 1353-1357 (November 2014) DOI: 10.1016/j.jvs.2013.08.018 Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 1 Graft of patient Allo 1, who was an 80-year-old woman with glomerulonephritis and coronary artery disease. She had been receiving hemodialysis for 4.5 years, with previous failures of an ambilateral brachial-cephalic access and of tunneled hemodialysis catheters in multiple locations, recurrent catheter infections and thromboses, hospitalizations for pneumonia, and lower limb deep venous thrombosis. A, Preimplantation hematoxylin and eosin staining of the devitalized graft showed the same organization as a living graft,5 but with dense nuclear remnants in the outer layers. B, Macroscopic view shows the implanted graft. Doppler ultrasound results at (C) 1 month, (D) 6 months, and (E) 11 months (composites from scan of entire length of graft) demonstrated no evidence of aneurysm or wall degradation. At 11 months, restenosis was noted near the medial anastomosis (MA), 6 months after percutaneous transluminal angioplasty. Flow was 1.3, 0.7, and 0.4 L/min at 1, 6, and 11 months, respectively. Blood test results before implantation and after 2 and 7 weeks: white blood cells (normal reference range, 4.0-10.0 × 103/μL): 5.1, 5.1, and 5.7 × 103/μL; lymphocytes (normal reference range, 20.5%-45.5%): 22.3%, 35.4%, and 23.7%; T-lymphocytes (normal reference range, 59.0%-85.0%): 77.8%, 73.3%, and 78.3%; T-helper (CD3+4+) cells (normal reference range, 29.0%-57.0%): 42.1%, 42.9%, and 40.7%; and T-suppressor/cytotoxic (CD3+8+) lymphocyte (normal reference range, 11.0%-38.0%): 32.8%, 33.3%, and 32.9%. Donor-specific cross-match and panel reactive antibody (PRA) test results at 7 and 24 weeks after implantation were negative. AA, Arterial anastomosis; VA, venous anastomosis. Journal of Vascular Surgery 2014 60, 1353-1357DOI: (10.1016/j.jvs.2013.08.018) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 2 Patient Allo 2 was a 60-year-old woman with coronary heart disease, hypertension, epilepsy, and polycystic kidney disease. She had been receiving hemodialysis for 2.5 years. A previous Gracz arteriovenous fistula failed to mature, and tunneled catheters in bilateral jugular veins suffered recurrent thrombosis. Doppler ultrasound results at 6 weeks showed no evidence of aneurysm or wall degradation. The flow was 1.9 L/min. Blood test results before implantation and after 2 and 7 weeks: white blood cells (normal reference range, 4.0-10.0 × 103/μL): 8.7, 6.2, and 5.0 ×103/μL; lymphocytes (normal reference range, 20.5%-45.5%): 8.7%, 18.9%, and 17.4%; T-lymphocytes (normal reference range, 59.0%-85.0%): 83.0%, 82.7%, and 88.2%; T-helper (CD3+4+) cells (normal reference range, 29.0%-57.0%): 67.6%, 48.8%, and 64.0%; and T-suppressor/cytotoxic (CD3+8+) lymphocyte (normal reference range, 11.0%-38.0%): 13.5%, 32.5%, and 18.3%. Panel reactive antibody (PRA) before implantation and at 4 and 7 weeks after was 0%. AA, Arterial anastomosis; MA, medial anastomosis; VA, venous anastomosis. Journal of Vascular Surgery 2014 60, 1353-1357DOI: (10.1016/j.jvs.2013.08.018) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 3 Patient Allo 3 was a 57-year-old woman with a history of diabetes, hypertension, and generalized atherosclerosis. She had been receiving hemodialysis for >2 years. Previous radial-cephalic wrist and brachial-cephalic upper arm access functioned only 10 days and 2.5 months, respectively. Vascular access for dialysis was with nontunneled and tunneled catheters in the bilateral internal jugulars and the right femoral vein. She was hospitalized five times with catheter infections during an 18-month period. Doppler ultrasound results after (A) 1 month and (B) 5 months show no evidence of aneurysm or wall degradation. Visible remnant narrowing was seen 2 months after graft thrombectomy and stent implantation. Flow was 1.8 L/min at 1 month and 0.6 L/min at 5 months. Blood test results before implantation and after 2 and 7 weeks: white blood cell (normal reference range, 4.0-10.0 × 103/μL): 4.9, 6.6, and 5.4 × 103/μL; lymphocytes (normal reference range, 20.5%-45.5%): 29.4%, 28.0%, and 28.2%; T-lymphocytes (normal reference range, 59.0%-85.0%): 79.3%, 73.3%, and 64.7%; T-helper (CD3+4+) lymphocytes (normal reference range, 29.0%-57.0%): 51.1%, 42.7%, and 32.8%; and T-suppressor/cytotoxic (CD3+8+) lymphocyte (normal reference range, 11.0%-38.0%): 27.7%, 29.7%, and 19.1%. Panel reactive antibody (PRA) before implantation and at 4, 7, and 24 weeks after was 0%. AA, Arterial anastomosis; MA, medial anastomosis; VA, venous anastomosis. Journal of Vascular Surgery 2014 60, 1353-1357DOI: (10.1016/j.jvs.2013.08.018) Copyright © 2014 Society for Vascular Surgery Terms and Conditions