Singh Prabh G, Kilari Sreenivasulu, Negm Ahmed S, Pedersen Joanne M, Montonye Dan R, McGee Kiaran P, Collins Jeremy D, Misra Sanjay
Vascular and Interventional Radiology Translational Research Lab, Mayo Clinic, Rochester, Minnesota.
Department of Radiology, Mayo Clinic, Rochester, Minnesota.
J Vasc Interv Radiol. 2025 Feb;36(2):332-339.e10. doi: 10.1016/j.jvir.2024.10.020. Epub 2024 Oct 25.
To develop a porcine model for arteriovenous fistula (AVF) venous stenosis (VS) treated with percutaneous transluminal angioplasty (PTA), and to compare outcomes of plain ordinary balloon angioplasty (POBA) to paclitaxel drug-coated balloon (DCB) angioplasty.
Twelve castrated male Yorkshire pigs (4-5 months, 35-45 kg) underwent renal artery embolization to induce chronic kidney disease (CKD). Twenty-eight days later, AVF was created by anastomosing the left external jugular vein to left common carotid artery. The pigs were divided into a pilot group (n = 6) for optimizing the AVF technique (euthanized at Day 4) and a definitive group (n = 6) for validating PTA outcomes (euthanized at Day 42). Stenosis developed at juxta-anastomosis 28 days later and was treated with POBA (pilot group, n = 6; definitive group, n = 3) or DCB (definitive group only, n = 3). The definitive group underwent biweekly 4-dimensional flow magnetic resonance (MR) imaging.
All animals developed CKD, with significant increases in the levels of blood urea nitrogen (increase of median from 2.6 to 3.2 mmol/L; P < .001) and creatinine (increase of median from 10 to 187 μmol/L, P < .001). In the pilot group, 1 animal had an infected fistula, and AVF patency was 1/5. In the definitive group, the patency was 5/6 because the AVF technique was modified by resecting the sternomastoid muscle and increasing the spatulation. At Day 42 after PTA, the DCB-treated AVF outflow vein showed increasing but statistically insignificant blood flow compared with POBA (DCB, 209.8 mm ± 64.4, vs POBA, 170.9 mm ± 95.5; P = .934).
A porcine model of AVF VS treated with PTA was developed, with blood flow trends favoring DCB over POBA.
建立一种经皮腔内血管成形术（PTA）治疗动静脉内瘘（AVF）静脉狭窄（VS）的猪模型，并比较普通球囊血管成形术（POBA）与紫杉醇药物涂层球囊（DCB）血管成形术的效果。
12只去势雄性约克夏猪（4 - 5个月，35 - 45千克）接受肾动脉栓塞以诱导慢性肾脏病（CKD）。28天后，通过将左颈外静脉与左颈总动脉吻合建立AVF。猪被分为优化AVF技术的预试验组（n = 6，第4天安乐死）和验证PTA效果的确定组（n = 6，第42天安乐死）。28天后在吻合口附近出现狭窄，分别采用POBA（预试验组，n = 6；确定组，n = 3）或DCB（仅确定组，n = 3）进行治疗。确定组每两周接受一次四维血流磁共振（MR）成像检查。
所有动物均发生CKD，血尿素氮水平显著升高（中位数从2.6 mmol/L增至3.2 mmol/L；P <.001），肌酐水平也显著升高（中位数从10 μmol/L增至187 μmol/L，P <.001）。预试验组中，1只动物发生感染性内瘘，AVF通畅率为1/5。在确定组中，通畅率为5/6，因为通过切除胸锁乳突肌并增加血管吻合口长度对AVF技术进行了改进。PTA术后第42天，与POBA相比，DCB治疗的AVF流出静脉血流增加，但差异无统计学意义（DCB，209.8 mm ± 64.4，vs POBA，170.9 mm ± 95.5；P =.934）。
建立了一种用PTA治疗AVF VS的猪模型，血流趋势显示DCB优于POBA。
