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Photodynamic therapy reduces intimal hyperplasia in prosthetic vascular bypass grafts in a pig model.

Journal article
Authors J Heckenkamp
Stefan Mellander
Per Fogelstrand
Silke Breuer
J Brunkwall
Erney Mattsson
Published in European journal of vascular and endovascular surgery
Volume 34
Issue 3
Pages 333-9
ISSN 1078-5884
Publication year 2007
Published at Wallenberg Laboratory
Institute of Medicine, Department of Molecular and Clinical Medicine
Institute of Clinical Sciences
Pages 333-9
Language en
Keywords Anastomosis, Surgical, adverse effects, Animals, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation, adverse effects, instrumentation, Graft Occlusion, Vascular, etiology, pathology, prevention & control, Hyperplasia, prevention & control, Iliac Artery, drug effects, pathology, surgery, Inflammation, etiology, prevention & control, Laser Therapy, Male, Methylene Blue, pharmacology, therapeutic use, Models, Animal, Photochemotherapy, Photosensitizing Agents, pharmacology, therapeutic use, Pilot Projects, Polytetrafluoroethylene, Prosthesis Design, Sus scrofa, Time Factors, Tunica Intima, drug effects, pathology, surgery
Subject categories Vascular surgery


BACKGROUND: Bypass surgery has a failing frequency of 30% during the first year, mainly due to intimal hyperplasia (IH). This negative effect is most pronounced in artificial grafts. Photodynamic therapy (PDT) is a technique in which light activates photosensitizer dyes to produce free-radicals resulting in an eradication of cells in the vascular wall. The aim of this study was to determine the effectiveness of PDT to reduce IH in a preclinical porcine PTFE bypass model. MATERIAL AND METHODS: Ten pigs were used. After a pilot PDT dosimetry study (n=3) PTFE grafts were bilaterally placed into the circulation as bypasses from the common to the external iliac arteries (n=7). The right sides served as controls (C). Before implantation of the left grafts, the arterial connecting sites of the left distal anastomoses were PDT-treated. The arteries were pressurized at 180 mmHg for 5 minutes with the photosensitizer Methylene Blue (330 microg/ml), and thereafter endoluminally irradiated with laser light (lambda = 660 nm, 100 mW/cm(2), 150 J/cm(2)). After 4 weeks the specimens were retrieved and formalin fixed. Cross sections through the midportions of the distal anastomoses and the grafts were used for histology, immunohistochemistry to identify inflammatory cells and morphometric evaluation (n=7). RESULTS: No systemic side effects and no graft occlusions were noted. PDT-treated anastomoses showed reduced IH in the mid-portions of the anastomoses (Area of IH: microm(2)/microm graft: C: 6970+/-1536, PDT: 2734+/-2560; P<0.005) as well as in the grafts (C: 5391+/-4031, PDT: 777+/-1331; P<0.02). The number of inflammatory cells per microscopic field was increased after PDT (C: 24+/-16, PDT: 37+/-15; P<0.009). CONCLUSIONS: Adjuvant PDT, performed in an endovascular fashion, was a safe method to reduce prosthetic graftstenosis in a preclinical setting. This study underscores the clinical potential of PDT to inhibit the development of clinical bypass graftstenosis.

Page Manager: Webmaster|Last update: 9/11/2012

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