ABSTRACT
PURPOSE: To determine whether gamma brachytherapy can prevent in-stent stenosis in hemodialysis grafts. MATERIALS AND METHODS: Six-millimeter polytetrafluoroethylene arteriovenous grafts were created bilaterally in six dogs. After 1 month, Wallstents spanning the venous anastomosis were placed to accelerate restenosis. Gamma irradiation (12 Gy) was delivered endoluminally to one of the two grafts by using an iridium 192 source; thus, each animal served as its own control. Fistulography was performed monthly for 10 months or until graft thrombosis, with measurement of stenosis at each time point. At the conclusion of the study period, the treated area was examined histologically, and a computer model was used to calculate the volume of intimal hyperplasia. RESULTS: Delayed stent migration resulted in exclusion of one dog. In the remaining five dogs; maximum stenosis across all time intervals was less for the treated side (P < .04), and the volume of intimal hyperplasia was less for the treated side (P < .045). In one animal studied at 1 year, this trend reversed in terms of percentage stenosis but not total neointimal volume. CONCLUSION: Brachytherapy with 192Ir (gamma) delivered at the time of stent placement reduces restenosis in this hemodialysis graft model, but, depending on the parameter evaluated (stenosis vs total volume of neointima), the benefit may wane or even reverse with time.
Subject(s)
Arteriovenous Shunt, Surgical , Brachytherapy , Graft Occlusion, Vascular/radiotherapy , Renal Dialysis , Angiography , Animals , Blood Vessel Prosthesis , Dogs , Femoral Artery/diagnostic imaging , Femoral Artery/surgery , Femoral Vein/diagnostic imaging , Femoral Vein/surgery , Gamma Rays , Graft Occlusion, Vascular/diagnostic imaging , Polytetrafluoroethylene , StentsABSTRACT
The Instrument AB Scanditronix MM22 medical microtron provides ten electron beam energies from approximately 3 to 22 MeV. Isodose curves, depth dose curves, field uniformity, and other characteristics were measured in water and in polystyrene. The method of acceleration, dual scattering foil system, and collimation technique produce beams having features superior to many other medical electron accelerators. Maximum dose rates at isocenter varied from about 500 to over 900 cGy min-1, photon contamination from 0.6% to 4.1%, and surface doses from 70% to 95% of the maximum. Depth dose curves were indistinguishable from those with identical practical ranges of a scanned beam linac at energies less than 18 MeV, and field flatness was clearly superior to the scanned beam linac at standard treatment distances.
