Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
권호 표지

Feasibility of Endovascular Radiation Therapy Using Holmium-166 Filled Balloon Catheter in a Swine Hemodialysis Fistula Model: Preliminary Results

돼지 동정맥루 모델에서 홀미움-166 풍선도관을 이용한 혈관 내 방사선조사 치료의 실행가능성에 관한 예비 연구

  • Won, Jong-Yun (Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine) ;
  • Lee, Kwang-Hun (Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine) ;
  • Lee, Do-Yun (Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine) ;
  • Kim, Myoung-Soo (Department of Surgery, Yonsei University College of Medicine) ;
  • Kang, Byung-Chul (Department of Radiology, School of Medicine, Ewha Woman's University) ;
  • Kim, Seung-Jung (Department of Internal Medicine, School of Medicine, Ewha Woman's University)
  • 원종윤 (연세대학교 의과대학 영상의학교실, 방사선의과학연구소) ;
  • 이광훈 (연세대학교 의과대학 영상의학교실, 방사선의과학연구소) ;
  • 이도연 (연세대학교 의과대학 영상의학교실, 방사선의과학연구소) ;
  • 김명수 (연세대학교 의과대학 외과학교실) ;
  • 강병철 (이화여자대학교 의학전문대학원 영상의학과학교실) ;
  • 김승정 (이화여자대학교 의학전문대학원 내과학교실)
  • Published : 2011.08.01
⟨ Previous Next ⟩

Abstract

Purpose: To describe how to make a swine hemodialysis fistula model and report our initial experience to test the feasibility of endovascular radiation therapy with Holmium-166 filled balloon catheters. Materials and Methods: The surgical formation of arterio-venous fistula (AVF) was performed by end-to-side anastomosis of the bilateral jugular vein and carotid artery of 6 pigs. After 4 weeks, angiograms were taken and endovascular radiation was delivered to the venous side of AVF with Holmium-166 filled balloon catheters. Pigs were sacrificed 4 weeks after the radiation and AVFs were harvested for histological examination. Results: All animals survived without any morbidity during the experimental periods. The formation of fistula on the sides of necks was successful in 11 of the 12 pigs (92%). One AVF failed from the small jugular vein. On angiograms, 4 of the 11 AVFs showed total occlusion or significant stenosis and therefore, endovascular radiation could not be performed. Of 7 eligible AVFs, five underwent successful endovascular radiation and two AVFs did not undergo radiation for the control. Upon histologic analysis, one non-radiated AVF showed total occlusion and others showed intimal thickening from the neointimal hyperplasia. Conclusion: Formation of the swine carotid artery-jugular vein hemodialysis fistula model was successful. Endovascular radiation using a Holmium-166 filled balloon catheter was safe and feasible.

목적: 돼지 동정맥루 모델을 만드는 방법을 기술하고 이 모델을 이용하여 홀미움-166을 채운 풍선도관을 이용한 혈관 내 방사선조사 치료의 실행 가능성을 시험하고자 하였다. 대상과 방법: 돼지 6마리의 양측 경동맥과 경정맥을 문합하여 동정맥루를 형성하였다. 4주 후, 혈관조영술을 시행하였으며 동정맥루의 정맥부에 홀미움-166을 채운 풍선도관으로 혈관 내 방사선조사를 하였다. 돼지는 방사선조사 4주 후에 희생하여 동정맥루의 조직검사를 시행하였다. 결과: 실험 기간 중 실험동물의 이환율 및 사망률은 0%였고, 한 마리 돼지의 한쪽 동정맥루를 제외한 나머지 11개의 동정맥루 형성술은 성공적이었다(92%). 혈관조영술에서 2개의 동정맥루 폐쇄와 심각한 협착이 발견되었다. 7개의 개통된 동정맥루 중 5개는 방사선조사를 성공적으로 시행하였으며 나머지 2개는 대조군으로 방사선조사를 시행하지 않았다. 조직검사에서 방사선 조사를 시행하지 않았던 1개의 동정맥루에서 완전폐쇄를 보였으며 나머지 동정맥루는 신생내막증식에 의한 내막비후를 보였다. 결론: 돼지 경동맥, 경정맥 문합을 이용한 동정맥루 모델 형성은 성공적이었고, 홀미움-166을 채운 풍선도관을 이용한 혈관 내 방사선조사는 안전하며 실행 가능하였다.

Keywords

References

  1. Diskin CJ. Pharmacologic intervention to prevent hemodialysis vascular access thrombosis: the next generation of treatment? Kidney Int 2005;67:2505
  2. Windus DW. Permanent vascular access: a nephrologist's view. Am J Kidney Dis 1993;21:457-471 https://doi.org/10.1016/S0272-6386(12)80391-X
  3. Masaki T, Rathi R, Zentner G, Leypoldt JK, Mohammad SF, Burns GL, et al. Inhibition of neointimal hyperplasia in vascular grafts by sustained perivascular delivery of paclitaxel. Kidney Int 2004;66:2061-2069 https://doi.org/10.1111/j.1523-1755.2004.00985.x
  4. Quinn SF, Schuman ES, Demlow TA, Standage BA, Ragsdale JW, Green GS, et al. Percutaneous transluminal angioplasty versus endovascular stent placement in the treatment of venous stenoses in patients undergoing hemodialysis: intermediate results. J Vasc Interv Radiol 1995;6:851-855 https://doi.org/10.1016/S1051-0443(95)71200-3
  5. Sarac TP, Riggs PN, Williams JP, Feins RH, Baggs R, Rubin P, et al. The effects of low-dose radiation on neointimal hyperplasia. J Vasc Surg 1995;22:17-24 https://doi.org/10.1016/S0741-5214(95)70083-8
  6. Teirstein PS, Massullo V, Jani S, Russo RJ, Cloutier DA, Schatz RA, et al. Two-year follow-up after catheter-based radiotherapy to inhibit coronary restenosis. Circulation 1999;99:243-247 https://doi.org/10.1161/01.CIR.99.2.243
  7. Liermann DD, Bauernsachs R, Schopohl B, Böttcher HD. Five year follow-up after brachytherapy for restenosis in peripheral arteries. Semin Interv Cardiol 1997;2:133-137
  8. Johnson MS, McLennan G, Lalka SG, Whitfield RM, Dreesen RG. The porcine hemodialysis access model. J Vasc Interv Radiol 2001;12:969-977 https://doi.org/10.1016/S1051-0443(07)61578-4
  9. Trerotola SO, Carmody TJ, Timmerman RD, Bergan KA, Dreesen RG, Frost SV, et al. Brachytherapy for the prevention of stenosis in a canine hemodialysis graft model: preliminary observations. Radiology 1999;212:748-754 https://doi.org/10.1148/radiology.212.3.r99se28748
  10. Popma JJ, Suntharalingam M, Lansky AJ, Heuser RR, Speiser B, Teirstein PS, et al. Randomized trial of 90Sr/90Y beta-radiation versus placebo control for treatment of in-stent restenosis. Circulation 2002;106:1090-1096 https://doi.org/10.1161/01.CIR.0000027814.96651.72
  11. Grise MA, Massullo V, Jani S, Popma JJ, Russo RJ, Schatz RA, et al. Five-year clinical follow-up after intracoronary radiation: results of a randomized clinical trial. Circulation 2002;105:2737-2740 https://doi.org/10.1161/01.CIR.0000018126.87045.E0
  12. Joh CW, Park CH, Kang HJ, Oh YT, Chun, Kim HS, et al. Measurement of radiation absorbed dose in endovascular Ho-166 brachytherapy using a balloon angio-catheter. Nucl Med Commun 2000;21:959-964 https://doi.org/10.1097/00006231-200010000-00011
  13. Kanterman RY, Vesely TM, Pilgram TK, Guy BW, Windus DW, Picus D. Dialysis access grafts: anatomic location of venous stenosis and results of angioplasty. Radiology 1995;195:135-139
  14. Roy-Chaudhury P, Kelly BS, Narayana A, Desai P, Melhem M, Munda R, et al. Hemodialysis vascular access dysfunction from basic biology to clinical intervention. Adv Ren Replace Ther 2002;9:74-84 https://doi.org/10.1053/jarr.2002.33519
  15. Kim SJ, Masaki T, Leypoldt JK, Kamerath CD, Mohammad SF, Cheung AK. Arterial and venous smooth-muscle cells differ in their responses to antiproliferative drugs. J Lab Clin Med 2004;144:156-162 https://doi.org/10.1016/j.lab.2004.06.002
  16. Rodriguez VM, Grove J, Yelich S, Pearson D, Stein M, Pevec WC. Effects of brachytherapy on intimal hyperplasia in arteriovenous fistulas in a porcine model. J Vasc Interv Radiol 2002;13:1239-1246 https://doi.org/10.1016/S1051-0443(07)61971-X
  17. Malhotra S, Teirstein PS. The SCRIPPS trial--catheter-based radiotherapy to inhibit coronary restenosis. J Invasive Cardiol 2000;12:330-332
  18. King SB 3rd, Williams DO, Chougule P, Klein JL, Waksman R, Hilstead R, et al. Endovascular beta-radiation to reduce restenosis after coronary balloon angioplasty: results of the beta energy restenosis trial (BERT). Circulation 1998;97:2025-2030 https://doi.org/10.1161/01.CIR.97.20.2025
  19. Waksman R, Robinson KA, Crocker IR, Gravanis MB, Cipolla GD, King SB 3rd. Endovascular low-dose irradiation inhibits neointima formation after coronary artery balloon injury in swine. A possible role for radiation therapy in restenosis prevention. Circulation 1995;91:1533-1539 https://doi.org/10.1161/01.CIR.91.5.1533
  20. Kim HS, Cho YH, Kim JS, Oh YT, Kang HJ, Chun MS, et al. Effect of transcatheter endovascular radiation with holmium-166 on neointimal formation after balloon injury in porcine coronary artery. J Nucl Cardiol 2000;7:478-483 https://doi.org/10.1067/mnc.2000.107427
  21. Badal A, Kyprianou I, Badano A, Sempau J. Monte Carlo simulation of a realistic anatomical phantom described by triangle meshes: application to prostate brachytherapy imaging. Radiother Oncol 2008;86:99-103 https://doi.org/10.1016/j.radonc.2007.11.009
  22. Kwok CS, Prestwich WV, Wilson BC. Calculation of radiation doses for nonuniformity distributed beta and gamma radionuclides in soft tissue. Med Phys 1985;12:405-412 https://doi.org/10.1118/1.595752
  23. Kim JH, Lee JT, Kim EK, Won JY, Kim MJ, Lee JD, et al. Percutaneous sclerotherapy of renal cysts with a beta-emitting radionuclide, holmium-166-chitosan complex. Korean J Radiol 2004;5:128-133 https://doi.org/10.3348/kjr.2004.5.2.128