Purpose: Describe the immunohistologic changes in arteriovenous fistula (AVF) stenosis treated using plain old balloon angioplasty (POBA) versus paclitaxel drug-coated balloons (DCB) MATERIALS AND METHODS: Castrated male Yorkshire pigs (n = 12) 4-5 months old had chronic kidney disease (CKD) induced with renal artery embolization. Twenty-eight days later, a side-to-end anastomosis was created between the left common carotid artery to ipsilateral external jugular vein. Four weeks later, a juxta anastomotic stenosis was treated with balloon angioplasty (PTA) or DCB and animals euthanized at 4 [POBA (n=6)] and 42 days [POBA (n=3) or DCB (n=3)] for histomorphometric analysis with immunohistochemical staining for CD-68 (macrophages), FSP-1 (fibroblasts), α-SMA (smooth muscle cells, SMCs), CD-31 (endothelial), proliferation (Ki-67), and apoptosis (TUNEL).
Results: Two animals died at 14 and 28 days after PTA. There was a significant increase in the lumen (p=0.0431), neointima (p=0.0156 at day 4, p<0.001 at day 42), and neointima/media+adventitia ratio (p=0.0061 at day 4, p=0.0032 at day 42). DCB-treated vessels showed a significant decrease in the N/M+A ratio (p=0.0386) and cell density in the intima (p=0.0113) compared to POBA. Endothelial cells were significantly increased at 4 (p=0.0034) and 42 days (p=0.012); macrophages at 14 days (p=0.0094); fibroblasts at 4 (p=0.0025) and 42 days (p<0.001); and SMCs at 28 days (p=0.004). Ki-67 staining peaked at 28 days (p=0.0018), and TUNEL staining decreased at 4 (p=0.0012), 14 (p=0.0062), and 42 days (p=0.04).
Conclusions: After PTA, the lumen vessel area increases with fibroblast and SMCs peaking at 4, followed by macrophages, SMCs, and proliferation.
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