DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA.
Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL, USA.
J Vasc Access. 2024 May;25(3):713-727. doi: 10.1177/11297298221135621. Epub 2022 Nov 9.
Periadventitial biomaterials have been employed for nearly three decades to promote adaptive venous remodeling following hemodialysis vascular access creation in preclinical models and clinical trials. These systems are predicated on the combination of scaffolds, hydrogels, and/or particles with therapeutics (small molecules, proteins, genes, and cells) to prevent venous stenosis and subsequent maturation failure. Periadventitial biomaterial therapies have evolved from simple drug delivery vehicles for traditional drugs to more thoughtful designs tailored to the pathophysiology of access failure. The emergence of tissue engineering strategies and gene therapies are another exciting new direction. Despite favorable results in experimental and preclinical studies, no periadventitial therapy has been clinically approved to improve vascular access outcomes. After conducting an exhaustive review of the literature, we identify the seminal studies and clinical trials that utilize periadventitial biomaterials and discuss the key features of each biomaterial format and their respective shortcomings as they pertain to access maturation. This review provides a foundation from which clinicians, surgeons, biologists, and engineers can refer to and will hopefully inspire thoughtful, translatable treatments to finally address access failure.
近三十年来，人们一直在使用血管周围生物材料来促进血液透析血管通路建立后的适应性静脉重塑，这在临床前模型和临床试验中都得到了验证。这些系统基于支架、水凝胶和/或颗粒与治疗剂（小分子、蛋白质、基因和细胞）的结合，以防止静脉狭窄和随后的成熟失败。血管周围生物材料疗法已经从传统药物的简单药物输送载体发展为更具针对性的设计，以适应通路失败的病理生理学。组织工程策略和基因治疗的出现是另一个令人兴奋的新方向。尽管在实验和临床前研究中取得了良好的结果，但没有一种血管周围治疗方法被临床批准用于改善血管通路的结果。在对文献进行详尽回顾后，我们确定了利用血管周围生物材料的重要研究和临床试验，并讨论了每种生物材料的关键特性及其各自的缺点，因为它们与通路成熟有关。这篇综述为临床医生、外科医生、生物学家和工程师提供了一个参考基础，并希望能激发有意义的、可转化的治疗方法，最终解决通路失败的问题。
