To determine whether external beam irradiation delivered immediately after graft implantation can inhibit anastomotic intimal hyperplasia (IH) 1 month following polytetrafluoroethylene (PTFE) bypass in a sheep carotid...
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To determine whether external beam irradiation delivered immediately after graft implantation can inhibit anastomotic intimal hyperplasia (IH) 1 month following polytetrafluoroethylene (PTFE) bypass in a sheep carotid artery model, 23 sheep underwent bilateral bypass of the ligated common carotid artery with 8-mm PTFE immediately followed by a single dose of irradiation (15, 21, or 30 Gy) to one side. The 15 animals with bilaterally patent grafts were euthanized at 1 month and graft-arterial anastomoses harvested. Using computer-aided image analysis, IH areas and thicknesses were measured. Graft patency in this model was 83% at 1 month and did not differ according to treatment administered. In the control animals, IH was greatest at mid-anastomosis, but minimal within the native vessel. All three radiation doses markedly inhibited mid-anastomotic IH area and thickness. At the proximal anastomosis, 30 Gy reduced the IH area 20-fold, from 2.06 to 0.14 mm(2) (p < 0.0001 by ANOVA), and IH thickness 70-fold, from 29.0 to 0.4 m (p < 0.0002);similar effects were seen at the distal anastomosis. No adverse effects of radiation treatment were observed. External beam irradiation in doses of 15 to 30 Gy delivered in a single fraction immediately after operation markedly inhibits development of intimal hyperplasia 1 month following end-to-side anastomosis with PTFE in sheep.
Intimal hyperplasia is the abnormal proliferative response to endothelial injury that occurs after almost any manipulation of the interior of a blood vessel. A certain amount of intimal hyperplasia after angioplasty, ...
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Intimal hyperplasia is the abnormal proliferative response to endothelial injury that occurs after almost any manipulation of the interior of a blood vessel. A certain amount of intimal hyperplasia after angioplasty, stenting, and operation is inevitable and innocuous, but if excessive, can narrow the lumen enough to decrease blood flow. Irradiation of the endothelium to inhibit restenosis after coronary angioplasty and stenting has been extensively studied by interventional cardiologists and radiation oncologists over the past decade. Essentially no attention has been directed to radiation inhibition of the anastomotic intimal hyperplasia that normally occurs after conventional peripheral arterial bypass grafting.
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