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1.
Diagn Interv Imaging ; 104(7-8): 368-372, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36973119

RESUMO

PURPOSE: The purpose of this study was to evaluate the safety and efficacy of middle meningeal artery embolization (MMAE) performed under cone-beam computed tomography (CBCT) augmented guidance in patients with cancer. MATERIALS AND METHODS: Eleven patients with cancer (seven women, four men; median age, 75 years; age range: 42-87 years) who underwent 17 MMAEs under CBCT with a combination of particles and coils for chronic subdural hematoma (SDH) (n = 6), postoperative SDH (n = 3), or preoperative embolization of meningeal tumor (n = 2) from 2022 to 2023 were included. Technical success, fluoroscopy time (FT), reference dose (RD), kerma area product (KAP) were analyzed. Adverse events and outcomes were recorded. RESULTS: The technical success rate was 100% (17/17). Median MMAE procedure duration was 82 min (interquartile range [IQR]: 70, 95; range: 63-108 min). The median FT was 24 min (IQR: 15, 48; range: 21.5-37.5 min); the median RD was 364 mGy (IQR: 37, 684; range: 131.5-444.5 mGy); and the median KAP was 46.4 Gy.cm2 (9.6, 104.5; range: 30.2-56.6 Gy.cm2). No further interventions were needed. The adverse event rate was 9% (1/11), with one pseudoaneurysm at the puncture site in a patient with thrombocytopenia, which was treated by stenting. The median follow-up was 48 days (IQR; 14, 251; range: 18.5-91 days]. SDH reduced in 11 of 15 SDHs (73%) as evidenced by follow-up imaging, with a size reduction greater than 50% in 10/15 SDHs (67%) . CONCLUSION: MMAE under CBCT is a highly effective treatment option, but appropriate patient selection and careful consideration of potential risks and benefits is important for optimal patient outcomes.


Assuntos
Embolização Terapêutica , Neoplasias , Masculino , Humanos , Feminino , Idoso , Adulto , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Artérias Meníngeas/diagnóstico por imagem , Tomografia Computadorizada de Feixe Cônico/efeitos adversos , Tomografia Computadorizada de Feixe Cônico/métodos , Embolização Terapêutica/métodos , Resultado do Tratamento , Estudos Retrospectivos
2.
Tech Vasc Interv Radiol ; 25(4): 100866, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36404060

RESUMO

The vascular lab (VL) is a powerful tool in diagnosing arterial disease, including peripheral and aortic disease, which is cornerstone of many VLs. This article discusses the indications, protocol, and diagnostic criteria of noninvasive testing for peripheral arterial disease and contrast enhanced ultrasound after endovascular repair of aortic aneurysm.


Assuntos
Doenças da Aorta , Doenças Vasculares , Humanos , Artérias/diagnóstico por imagem , Ultrassonografia
3.
Tech Vasc Interv Radiol ; 25(4): 100865, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36404065

RESUMO

The vascular lab (VL) provides unequalled information regarding venous disease especially in the depiction and characterization of venous waveforms. This article provides the indications, protocol, and diagnostic criteria for peripheral and central venous disease and venous mapping. Venous evaluation is one of the most common studies performed at vascular labs (VL). Patient may present with swelling for evaluation of thrombosis, central obstruction, or venous insufficiency, or may need preoperative planning prior to a bypass or dialysis access creation. It is my hope that the added value a VL brings to the sonographic evaluation of veins, beyond the compressibility of the veins, is the utmost respect and attention to the depiction and characterization of the venous waveform.


Assuntos
Cateterismo Venoso Central , Doenças Vasculares , Insuficiência Venosa , Humanos , Cateterismo Venoso Central/métodos , Veias , Ultrassonografia
4.
Tech Vasc Interv Radiol ; 25(4): 100864, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36404066

RESUMO

The vascular lab (VL) provides vital information for dialysis access to guide management. This article discusses the indication, protocol, and diagnostic criteria for the evaluation of arteriovenous fistulas and grafts. An arteriovenous (AV) dialysis access is made by creating a connection between an artery and vein (AV fistula [AVF]) or by interposing a conduit between an artery and a vein (AV graft [AVG]) to provide high flow circuit for hemodialysis. A normal mature AV dialysis access has a thrill or vibration from turbulent flow in the graft or vein. The nomenclatures at our institution for an AVF and AVG are in the Figure 1 A and B diagrams.


Assuntos
Fístula Arteriovenosa , Derivação Arteriovenosa Cirúrgica , Humanos , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Derivação Arteriovenosa Cirúrgica/métodos , Diálise Renal , Veias , Artérias
5.
Curr Oncol Rep ; 24(10): 1351-1361, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35639331

RESUMO

PURPOSE OF REVIEW: The incidence of lymphatic leakage (iatrogenic and non-iatrogenic) is growing in cancer population due to the increased complexity of the surgical procedures and improved overall survival in cancer patients. The purpose of this article is to review the contemporary approach in the field of percutaneous lymphatic embolization in cancer patients with lymphatic leaks. RECENT FINDINGS: Since the advent of intranodal lymphangiography in 2011 alongside with the MR and CT lymphangiography, the accuracy of diagnosis of the lymphatic diseases has significantly improved significantly. These advancements have triggered a revival of minimally invasive lymphatic interventions. Lymphatic embolization is expanding from the classic indication, thoracic duct embolization, to other lymphatic disorders (chylous ascites, lymphoceles, liver lymphorrhea, protein-losing enteropathy). The growth of lymphatic research and the standardization of the lymphatic interventions require a multidisciplinary and collaborative approach between physicians and researchers.


Assuntos
Embolização Terapêutica , Neoplasias , Embolização Terapêutica/métodos , Humanos , Sistema Linfático/diagnóstico por imagem , Linfografia/métodos , Neoplasias/terapia , Ducto Torácico , Resultado do Tratamento
6.
Ultrasound Q ; 38(2): 103-115, 2022 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-35426378

RESUMO

ABSTRACT: Contrast-enhanced ultrasound (CEUS) continues to be an ever-growing tool in radiation-free imaging. While it has been widely used in cardiac imaging, CEUS has only recently become an Food and Drug Administration-approved and viable modality for evaluation of abdominal structures. Ultrasound contrast agents are nontoxic, microbubble-based vascular agents and can be used to reliably assess enhancement patterns of various lesions in real time. In particular, it's non nephrotoxic nature makes CEUS a particularly important tool in renal failure patients requiring serial follow-up. This review provides a comprehensive discussion on the utility of CEUS agents, imaging techniques, comparison with traditional cross-sectional imaging modalities, and its application in diagnosing kidney and liver lesions. This pictorial review is illustrated with cases of renal and hepatic lesions that the practicing radiologist should become familiar with as CEUS becomes increasingly popular.


Assuntos
Meios de Contraste , Neoplasias Hepáticas , Humanos , Neoplasias Hepáticas/diagnóstico , Microbolhas , Ultrassonografia/métodos
7.
J Clin Imaging Sci ; 11: 61, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34877068

RESUMO

OBJECTIVES: Pelvic congestion syndrome (PCS) is a challenging diagnosis to make secondary to nonspecific presenting symptoms and imaging findings. This retrospective review aims to discern predictive factors which can guide the decision to perform catheter-based venography and prognosticate outcomes. MATERIAL AND METHODS: A retrospective analysis of patients who underwent catheter venography for PCS between January 2014 and December 2019 was performed. Multiple factors, including patient demographics, clinical history, pre-procedural imaging, venographic findings, and treatment outcomes 180 days post-procedure, were included in the analysis. Venographic findings were used to separate patients into two groups (positive or negative), with these factors compared across groups. Regression analysis controlled for the confounding effects of age and body mass index (BMI). Treated subjects were separated based on outcome (partial, no response, complete response, or technical failure), and comparisons were performed. RESULTS: Eighty patients were included in the initial analysis. Two patients were excluded due to prior embolization or portal hypertension. Seventy-eight patients were included in the final analysis. Sixty-two patients had positive findings, and 16 had no venographic findings to suggest PCS. A history of prior pregnancy was a significant predictor of positive venographic results (odds ratio = 5.99, P = 0.007). BMI was significantly lower in those with positive venographic results (P = 0.047). Presence of concomitant diagnoses did not affect venographic findings or treatment outcomes. No factors predicted treatment outcomes. Five of the treated patients had subsequent successful pregnancies. CONCLUSION: A lower BMI supports the decision to perform venography for suspected PCS. In addition, patients who carried concomitant potentially confounding diagnoses for chronic pelvic pain were found to have similar rates of venographic findings suggesting PCS, as well as similar treatment outcomes.

8.
J Emerg Trauma Shock ; 14(3): 148-152, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34759633

RESUMO

INTRODUCTION: Evaluate outcomes and radiation exposure across different splenic artery embolization (SAE) techniques for splenic injuries secondary to blunt trauma. METHODS: This retrospective cohort study included patients 18 years of age or older who underwent SAE for splenic injury after blunt trauma from January 2011 to June 2019. RESULTS: Sixty patients underwent angiography for splenic injury after blunt traumatic injury. Forty-four patients were embolized. Seventeen patients underwent proximal SAE, and 23 underwent distal SAE. Four patients had a combination of proximal and distal SAE. Eleven patients had subsequent major complications requiring splenectomy. There was no significant difference in major complication rate when comparing proximal SAE 29.4% versus distal SAE 21.7%. No significant difference was noted across the two groups with respect to age or grade of injury. There was a statistically significant difference (P = 0.004) in fluoroscopy time between the proximal 10.1 ± 4.2 min and distal group 17.8 ± 8.7 min. No statically significant difference was found in major complications when comparing coil versus gel foam embolization. CONCLUSION: Proximal SAE is associated with a significantly lower fluoroscopy time (P = 0.004). Complication rates are similar after proximal and distal SAE. No significant difference was found in major complication rates comparing coil versus gel foam embolization. Minor complications more commonly occurred after proximal embolization with gel-foam.

9.
Ultrasound Q ; 37(3): 219-228, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34478419

RESUMO

ABSTRACT: Pelvic venous disorders are a group of interrelated conditions characterized by venous incompetence. These conditions often manifest with nonspecific symptoms that overlap with many gynecological, gastrointestinal, and urologic diseases. Clinical diagnosis can be difficult, and imaging can play a vital role in differentiating etiology. Sonographic evaluation is often the first step in evaluating these symptoms. Special attention to possible underlying pelvic venous disorders can reveal characteristic findings, support diagnosis, and guide treatment. Here we review pelvic congestion syndrome, nutcracker syndrome, May-Thurner syndrome, and other venous disorders, with a specific focus on sonographic findings and considerations.


Assuntos
Pelve , Doenças Vasculares , Humanos , Dor Pélvica , Pelve/diagnóstico por imagem , Ultrassonografia , Veias
10.
J Clin Imaging Sci ; 10: 16, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32363078

RESUMO

OBJECTIVE: To determine, time to angiography for patients with positive gastrointestinal bleeding (GIB) on prior investigation (endoscopy [ES], nuclear medicine [NM] Tc99m red blood cells (RBC) scan, or computed tomography angiography), affects angiographic bleed identification. MATERIALS AND METHODS: Visceral Angiograms performed from January 2012 to August 2017 were evaluated. Initial angiograms performed for GIB were included in the study. Exclusion criteria included recent abdominal surgery or procedure (30 days), empiric embolization (embolization without visualized active bleeding), and use of vasodilators, or subsequent angiogram. Timing and results of ES, NM Tc99m RBC scan, or computed tomography angiogram and catheter angiogram were recorded. In addition, age, gender, angiogram time, anti- platelet therapy, anti-coagulation therapy, bleed location, international normalized ratio, and units of packed RBCs received in the 24 h before catheter angiography were included in the study. RESULTS: One hundred and seventy angiograms were included in the final analysis. Forty-three angiograms resulted in the identification of an active bleed (68.9 years, and 67.4% male). All of these patients were embolized successfully. One hundred and twenty-seven angiograms failed to identify an active bleed (70.4 years, and 49.6% male). No significance was found across the two groups with respect to time from prior positive investigation. Receiver operating characteristic analysis demonstrated that units of packed RBCs received in the preceding 24 h were correlated with positive bleed identification on catheter angiography. CONCLUSION: Time to angiography from prior positive investigation, including ES, NM Tc99m RBC scan, or computed tomography angiogram does not correlate with positive angiographic outcomes. Increasing units of packed RBCs administered in the 24 h before angiogram do correlate with positive angiographic findings.

11.
Radiol Case Rep ; 15(4): 396-399, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32071658

RESUMO

Gastrointestinal manifestations of post-transplant lymphoproliferative disorder (GI-PTLD) encompasses a spectrum of mucosal inflammation and ulceration that can present as severe acute gastrointestinal bleed. This case report describes a case of GI-PTLD in a 19-year-old female status postcardiac transplant. This patient presented with extensive gastrointestinal hemorrhage secondary to PTLD involving the duodenum. The patient was treated with extensive embolization of the gastroduodenal artery and the pancreaticoduodenal arcades. Embolization was used to mitigate gastrointestinal bleeding, thus preventing the need for surgical resection and extensive reconstruction. This case report demonstrates the utility of embolization as potential therapeutic option in the setting of GI-PTLD in addition to medical and endoscopic therapy.

12.
Insights Imaging ; 11(1): 19, 2020 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-32034537

RESUMO

Vascular lesions have a varied appearance and can commonly occur in the head and neck. A majority of these lesions are cutaneous and congenital; however, some may be acquired and malignant. The presentation and clinical history of patients presenting with head and neck lesions can be used to guide further imaging, which can provide important diagnostic and therapeutic considerations. This review discusses the revised International Society for the Study of Vascular Anomalies (ISSVA) classification system for vascular tumors and malformations, as well as explores the most common vascular anomalies including their clinical presentations and imaging findings.

13.
Sci Rep ; 7(1): 14298, 2017 10 30.
Artigo em Inglês | MEDLINE | ID: mdl-29085001

RESUMO

Venous neointimal hyperplasia (VNH) at the outflow vein of hemodialysis AVF is a major factor contributing to failure. CorMatrix is an extracellular matrix that has been used in cardiovascular procedures primarily as scaffolding during surgery. In the present study, we sought to determine whether CorMatrix wrapped around the outflow vein of arteriovenous fistula (AVF) at the time of creation could reduce VNH. In mice, the carotid artery to the ipsilateral jugular vein was connected to create an AVF, and CorMatrix scaffold was wrapped around the outflow vein compared to control mice that received no scaffolding. Immunohistochemistry, Western blot, and qRT-PCR were performed on the outflow vein at 7 and 21 days after AVF creation. In outflow veins treated with CorMatrix, there was an increase in the mean lumen vessel area with a decrease in the ratio of neointima area/media + adventitia area (P < 0.05). Furthermore, there was a significant increase in apoptosis, with a reduction in cell density and proliferation in the outflow veins treated with CorMatrix compared to controls (P < 0.05). Immunohistochemical analysis revealed a significant reduction in fibroblasts, myofibroblasts, macrophages, and leukocytes with a reduction in Tnf-α gene expression (P < 0.05). In conclusion, outflow veins treated with CorMatrix have reduced VNH.


Assuntos
Túnica Adventícia/patologia , Fístula Arteriovenosa/patologia , Fístula Arteriovenosa/prevenção & controle , Hiperplasia/prevenção & controle , Diálise Renal/efeitos adversos , Alicerces Teciduais , Animais , Apoptose/fisiologia , Artérias Carótidas/cirurgia , Proliferação de Células/fisiologia , Matriz Extracelular/fisiologia , Fibroblastos/citologia , Veias Jugulares/cirurgia , Leucócitos/citologia , Macrófagos/citologia , Camundongos , Camundongos Transgênicos , Modelos Animais , Miofibroblastos/citologia , Insuficiência Renal Crônica/terapia , Fator de Necrose Tumoral alfa/análise
14.
Tech Vasc Interv Radiol ; 19(2): 145-52, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27423996

RESUMO

Peripheral arterial disease (PAD) affects over 8 million people in the United States alone. Although great strides have been made in reducing the burden of cardiovascular disease the prevalence of PAD is expected to rise with the age of global population. PAD characterized by narrowing of arterial blood can be asymptomatic or cause limb threatening claudication. It has been classically treated with bypass, but these techniques have been supplanted by endovascular therapy. Plain old balloon angioplasty has been successful in helping revascularize lesions, but its effect has not been durable because of restenosis. This prompted the creation of several technologies aimed at reducing restenosis. These advances slowly improved outcomes and the durability of endovascular management. Among the main tools used in current endovascular practice are drug-delivery devices aimed at inhibiting the inflammatory and proliferative pathways that lead to restenosis. This article examines the current drug-delivery technologies used in the superficial femoral artery.


Assuntos
Fármacos Cardiovasculares/administração & dosagem , Materiais Revestidos Biocompatíveis , Sistemas de Liberação de Medicamentos/instrumentação , Stents Farmacológicos , Procedimentos Endovasculares/instrumentação , Artéria Femoral/efeitos dos fármacos , Doença Arterial Periférica/terapia , Radiografia Intervencionista , Dispositivos de Acesso Vascular , Constrição Patológica , Composição de Medicamentos , Procedimentos Endovasculares/efeitos adversos , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/fisiopatologia , Humanos , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Desenho de Prótese , Recidiva , Fatores de Risco , Resultado do Tratamento
15.
Semin Intervent Radiol ; 33(1): 15-20, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27011423

RESUMO

Arteriovenous fistulas (AVFs) are essential for patients and clinicians faced with end-stage renal disease (ESRD). While this method of vascular access for hemodialysis is preferred to others due to its reduced rate of infection and complications, they are plagued by intimal hyperplasia. The pathogenesis of intimal hyperplasia and subsequent thrombosis is brought on by uremia, hypoxia, and shear stress. These forces upregulate inflammatory and proliferative cytokines acting on leukocytes, fibroblasts, smooth muscle cells, and platelets. This activation begins initially with the progression of uremia, which induces platelet dysfunction and primes the body for an inflammatory response. The vasculature subsequently undergoes changes in oxygenation and shear stress during AVF creation. This propagates a strong inflammatory response in the vessel leading to cellular proliferation. This combined response is then further subjected to the stressors of cannulation and dialysis, eventually leading to stenosis and thrombosis. This review aims to help interventional radiologists understand the biological changes and pathogenesis of access failure.

16.
Kidney Int ; 89(2): 303-316, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26806833

RESUMO

The arteriovenous fistula has been used for more than 50 years to provide vascular access for patients undergoing hemodialysis. More than 1.5 million patients worldwide have end stage renal disease and this population will continue to grow. The arteriovenous fistula is the preferred vascular access for patients, but its patency rate at 1 year is only 60%. The majority of arteriovenous fistulas fail because of intimal hyperplasia. In recent years, there have been many studies investigating the molecular mechanisms responsible for intimal hyperplasia and subsequent thrombosis. These studies have identified common pathways including inflammation, uremia, hypoxia, sheer stress, and increased thrombogenicity. These cellular mechanisms lead to increased proliferation, migration, and eventually stenosis. These pathways work synergistically through shared molecular messengers. In this review, we will examine the literature concerning the molecular basis of hemodialysis vascular access malfunction.


Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Neointima/etiologia , Animais , Humanos , Falência Renal Crônica/terapia , Diálise Renal/métodos
17.
Radiology ; 279(2): 513-22, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26583911

RESUMO

PURPOSE: To determine if adventitial transplantation of human adipose tissue-derived mesenchymal stem cells (MSCs) to the outflow vein of B6.Cg-Foxn1(nu)/J mice with arteriovenous fistula (AVF) at the time of creation would reduce monocyte chemoattractant protein-1 (Mcp-1) gene expression and venous neointimal hyperplasia. The second aim was to track transplanted zirconium 89 ((89)Zr)-labeled MSCs serially with positron emission tomography (PET) for 21 days. MATERIALS AND METHODS: All animal experiments were performed according to protocols approved by the institutional animal care and use committee. Fifty B6.Cg-Foxn1(nu)/J mice were used to accomplish the study aims. Green fluorescent protein was used to stably label 2.5 × 10(5) MSCs, which were injected into the adventitia of the outflow vein at the time of AVF creation in the MSC group. Eleven mice died after AVF placement. Animals were sacrificed on day 7 after AVF placement for real-time polymerase chain reaction (n = 6 for MSC and control groups) and histomorphometric (n = 6 for MSC and control groups) analyses and on day 21 for histomorphometric analysis only (n = 6 for MSC and control groups). In a separate group of experiments (n = 3), animals with transplanted (89)Zr-labeled MSCs were serially imaged with PET for 3 weeks. Multiple comparisons were performed with two-way analysis of variance, followed by the Student t test with post hoc Bonferroni correction. RESULTS: In vessels with transplanted MSCs compared with control vessels, there was a significant decrease in Mcp-1 gene expression (day 7: mean reduction, 62%; P = .029), with a significant increase in the mean lumen vessel area (day 7: mean increase, 176% [P = .013]; day 21: mean increase, 415% [P = .011]). Moreover, this was accompanied by a significant decrease in Ki-67 index (proliferation on day 7: mean reduction, 81% [P = .0003]; proliferation on day 21: mean reduction, 60%, [P = .016]). Prolonged retention of MSCs at the adventitia was evidenced by serial PET images of (89)Zr-labeled cells. CONCLUSION: Adventitial transplantation of MSCs decreases Mcp-1 gene expression, accompanied by a reduction in venous neointimal hyperplasia.


Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Transplante de Células-Tronco Mesenquimais , Neointima/patologia , Tecido Adiposo/citologia , Animais , Humanos , Hiperplasia/patologia , Hiperplasia/prevenção & controle , Marcação In Situ das Extremidades Cortadas , Camundongos , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Reação em Cadeia da Polimerase em Tempo Real
18.
PLoS One ; 9(7): e102542, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25036043

RESUMO

Arteriovenous fistulas (AVFs) used for hemodialysis fail because of venous neointimal hyperplasia (VNH). There are 1,500,000 patients that have end stage renal disease worldwide and the majority requires hemodialysis. In the present study, the role of the intermediate early response gene X-1 (IEX-1), also known as IER-3 in the pathogenesis of VNH was evaluated. In human samples removed from failed AVF, there was a significant increase in IEX-1 expression localized to the adventitia. In Iex-1-/- mice and wild type (WT) controls, chronic kidney disease was induced and an AVF placed 28 days later by connecting the carotid artery to jugular vein. The outflow vein was removed three days following the creation of the AVF and gene expression analysis demonstrated a significant decrease in vascular endothelial growth factor-A (Vegf-A) and monocyte chemoattractant protein-1 (Mcp-1) gene expression in Iex-1-/- mice when compared to WT mice (P<0.05). At 28 days after AVF placement, histomorphometric and immune-histochemical analyses of the outflow vein demonstrated a significant decrease in neointimal hyperplasia with an increase in average lumen vessel area associated with a decrease in fibroblast, myofibroblast, and Ly6C staining. There was a decrease in proliferation (Ki-67) and an increase in the TUNEL staining in Iex-1 KO mice compared to WT. In addition, there was a decrease in Vegf-A, Mcp-1, and matrix metalloproteiniase-9 (Mmp-9) staining. Iex-1 expression was reduced in vivo and in vitro using nanoparticles coated with calcitriol, an inhibitor of Iex-1 that demonstrated that Iex-1 reduction results in decrease in Vegf-A. In aggregate, these results indicate that the absence of IEX-1 gene results in reduced VNH accompanied with a decrease in proliferation, reduced fibroblast, myofibroblast, and Ly6C staining accompanied with increased apoptosis mediated through a reduction in Vegf-A/Mcp-1 axis and Mmp-9. Adventitial delivery of nanoparticles coated with calcitriol reduced Iex-1 and VNH.


Assuntos
Proteínas Reguladoras de Apoptose/fisiologia , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Proteínas Imediatamente Precoces/deficiência , Proteínas de Membrana/fisiologia , Diálise Renal , Túnica Íntima/patologia , Veias/patologia , Animais , Apoptose , Proteínas Reguladoras de Apoptose/análise , Calcitriol/administração & dosagem , Calcitriol/farmacologia , Calcitriol/uso terapêutico , Quimiocina CCL2/biossíntese , Quimiocina CCL2/genética , Fibroblastos/patologia , Humanos , Hidrogéis , Hiperplasia , Proteínas Imediatamente Precoces/fisiologia , Falência Renal Crônica/terapia , Ácido Láctico , Masculino , Metaloproteinase 9 da Matriz/biossíntese , Metaloproteinase 9 da Matriz/genética , Proteínas de Membrana/análise , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Miofibroblastos/patologia , Nanopartículas , Ácido Poliglicólico , Copolímero de Ácido Poliláctico e Ácido Poliglicólico , Túnica Íntima/metabolismo , Fator A de Crescimento do Endotélio Vascular/biossíntese , Fator A de Crescimento do Endotélio Vascular/genética
19.
PLoS One ; 9(4): e94510, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24732590

RESUMO

Hemodialysis vascular access can develop venous neointimal hyperplasia (VNH) causing stenosis. Recent clinical and experimental data has demonstrated that there is increased expression of a disintegrin and metalloproteinase thrombospondin motifs-1 (ADAMTS-1) at site of VNH. The experiments outlined in the present paper were designed to test the hypothesis that targeting of the adventitia of the outflow vein of murine arteriovenous fistula (AVF) using a small hairpin RNA that inhibits ADAMTS-1 expression (LV-shRNA-ADAMTS-1) at the time of fistula creation will decrease VNH. At early time points, ADAMTS-1 expression was significantly decreased associated with a reduction in vascular endothelial growth factor-A (VEGF-A) and matrix metalloproteinase-9 (MMP-9) (LV-shRNA-ADAMTS-1 transduced vessels vs. controls). These changes in gene and protein expression resulted in favorable vascular remodeling with a significant increase in mean lumen vessel area, decrease in media/adventitia area, with a significant increase in TUNEL staining accompanied with a decrease in cellular proliferation accompanied with a reduction in CD68 staining. Collectively, these results demonstrate that ADAMTS-1 transduced vessels of the outflow vein of AVF have positive vascular remodeling.


Assuntos
Proteínas ADAM/metabolismo , Túnica Adventícia/patologia , Fístula Arteriovenosa/patologia , Lentivirus/metabolismo , RNA Interferente Pequeno/metabolismo , Proteína ADAMTS1 , Animais , Antígenos CD/metabolismo , Antígenos de Diferenciação Mielomonocítica/metabolismo , Apoptose , Fístula Arteriovenosa/metabolismo , Fístula Arteriovenosa/cirurgia , Nitrogênio da Ureia Sanguínea , Proliferação de Células , Constrição Patológica , Creatinina/sangue , Técnicas de Transferência de Genes , Masculino , Metaloproteinase 9 da Matriz/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , Células NIH 3T3 , Nefrectomia , Coloração e Rotulagem , Transdução Genética , Fator A de Crescimento do Endotélio Vascular/metabolismo , Remodelação Vascular
20.
J Vasc Res ; 51(6): 458-67, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25677750

RESUMO

PURPOSE: Hypoxic conditions cause fibroblasts to differentiate into alpha smooth-muscle cell actin (α -SMA)-positive cells, i.e. myofibroblasts. This process is a hallmark of venous neointimal hyperplasia (VNH) associated with hemodialysis vascular access. The purpose of this study was to determine if blood outgrowth endothelial cells (BOEC) may reduce the conversion of fibroblasts into myofibroblasts under hypoxic conditions, and to determine the potential mechanisms involved. METHODS: An experimental model was used, in which fibroblasts and BOEC were subjected to hypoxia under contact and transwell conditions to determine if BOEC reduce the conversion of fibroblasts into myofibroblasts under hypoxic conditions. Gene expression under different conditions was performed. In addition, functional assays including cell proliferation and migration were determined. RESULTS: This study demonstrates that contact needs to occur between BOEC and fibroblasts for the reduction of the hypoxia-driven conversion of fibroblasts into α-SMA. This is associated with a decrease in several proangiogenic genes including vascular endothelial growth factor A, platelet-derived growth factor, fibroblast growth factor and matrix metalloproteinase 2 in fibroblasts in contact with BOEC when compared to fibroblasts alone. In addition, migration is significantly reduced while proliferation remains unchanged. CONCLUSION: This study helps provide rationale for using BOEC delivered to the adventitia of the outflow vein of hemodialysis vascular access to reduce VNH.


Assuntos
Proteínas Angiogênicas/metabolismo , Comunicação Celular , Transdiferenciação Celular , Citocinas/metabolismo , Células Endoteliais/metabolismo , Fibroblastos/metabolismo , Actinas/metabolismo , Proteínas Angiogênicas/genética , Animais , Hipóxia Celular , Movimento Celular , Proliferação de Células , Tamanho Celular , Células Cultivadas , Técnicas de Cocultura , Citocinas/genética , Regulação para Baixo , Células Endoteliais da Veia Umbilical Humana/metabolismo , Humanos , Metaloproteinase 9 da Matriz/metabolismo , Miofibroblastos/metabolismo , Fenótipo , Transdução de Sinais , Suínos , Fatores de Tempo
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