J Korean Soc Radiol.  2011 Aug;65(2):119-125. 10.3348/jksr.2011.65.2.119.

Feasibility of Endovascular Radiation Therapy Using Holmium-166 Filled Balloon Catheter in a Swine Hemodialysis Fistula Model: Preliminary Results

• Won JY
• Lee KH
• Lee DY
• Kim MS
• Kang BC
• Kim SJ

• KMID: 1443473
• DOI: http://doi.org/10.3348/jksr.2011.65.2.119

Abstract

PURPOSE
To describe how to make a swine hemodialysis fistula model and report our initial experience to test the feasibility of endovascular radiation therapy with Holmium-166 filled balloon catheters.
MATERIALS AND METHODS
The surgical formation of arterio-venous fistula (AVF) was performed by end-to-side anastomosis of the bilateral jugular vein and carotid artery of 6 pigs. After 4 weeks, angiograms were taken and endovascular radiation was delivered to the venous side of AVF with Holmium-166 filled balloon catheters. Pigs were sacrificed 4 weeks after the radiation and AVFs were harvested for histological examination.
RESULTS
All animals survived without any morbidity during the experimental periods. The formation of fistula on the sides of necks was successful in 11 of the 12 pigs (92%). One AVF failed from the small jugular vein. On angiograms, 4 of the 11 AVFs showed total occlusion or significant stenosis and therefore, endovascular radiation could not be performed. Of 7 eligible AVFs, five underwent successful endovascular radiation and two AVFs did not undergo radiation for the control. Upon histologic analysis, one non-radiated AVF showed total occlusion and others showed intimal thickening from the neointimal hyperplasia.
CONCLUSION
Formation of the swine carotid artery-jugular vein hemodialysis fistula model was successful. Endovascular radiation using a Holmium-166 filled balloon catheter was safe and feasible.

MeSH Terms

Animals
Arteriovenous Fistula
Brachytherapy
Carotid Arteries
Catheters
Constriction, Pathologic
Fistula
Holmium
Jugular Veins
Neck
Renal Dialysis
Swine
Veins
Holmium

Figure

• 

  Fig. 1 Photograph of the arteriovenous fistula in a pig. After cutting the distal end, internal jugular vein (arrow) was sutured to the common carotid artery using the end-to-side anastomosis method.

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  Fig. 2 Angiogram of the arteriovenous fistula of the pig. After placing a 5F catheter at the common carotid artery, 15 mL of contrast material was injected at a rate of 5 mL/second. Bead-like multifocal stenoses are noted in venous side just below the arteriovenous anastomosis site of the fistula.

• 

  Fig. 3 Histologic section of venous limb of AVF with radiation (H & E stain, × 40). The section was performed at the venous segment with a stricture. Prominent neointimal hyperplasia with smooth muscle cell proliferation is seen (arrow). The maximal thickeness of the intima is about 1.2 mm. Note.-AVF = arterio-venous fistula

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