Highly increased cell proliferation activity in the restenotic hemodialysis vascular access after percutaneous transluminal angioplasty: implication in prevention of restenosis.
BACKGROUND
The effect of percutaneous transluminal angioplasty (PTA) in the treatment of hemodialysis vascular access stenosis is attenuated by a high restenosis rate, which results mainly from neointimal hyperplasia. Cellular proliferation is one of the most important biological mechanisms involved in neointimal hyperplasia and may be a potential target of intervention to prevent restenosis.


METHODS
We investigated the activity of cellular proliferation of restenotic lesions by means of immunohistochemistry, using an antibody to the proliferating cell nuclear antigen. Specimens from 10 primary stenotic and 20 restenotic lesions of 30 Brescia-Cimino fistulae were obtained during revision.


RESULTS
The proliferation index of the restenotic group was strikingly significantly greater than that of the primary stenotic group (intima, P < 0.001; media, P = 0.001). Proliferation indices of patients with diabetes in the restenotic group were significantly higher than those of patients without diabetes (intima, P = 0.028; media, P = 0.002). In the restenotic group, proliferation indices correlated negatively with the interval from PTA to restenosis (intima, r = -0.741; P < 0.001; media, r = -0.589; P = 0.006) and positively with the number of PTAs per lesion (intima, r = 0.754; P < 0.001; media, r = 0.506; P = 0.004).


CONCLUSIONS
We show markedly high cellular proliferation activity in early restenotic lesions of arteriovenous fistulae. These findings indicate that adjunctive antiproliferative therapy is mandatory in preventing restenosis after PTA, especially in patients with diabetes.
Chang
Chi-Jen
CJ
First Cardiovascular Division, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan. cchijen@adm.cgmh.org.tw
Ko
Po-Jen
PJ
Hsu
Lung-An
LA
Ko
Yu-Shien
YS
Ko
Yu-Lin
YL
Chen
Chin-Fen
CF
Huang
Chiu-Ching
CC
Hsu
Tsu-Shiu
TS
Lee
Ying-Shiung
YS
Pang
Jong-Hwei S
JH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000800:Angioplasty, Balloon; D001166:Arteriovenous Shunt, Surgical; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002455:Cell Division; D003251:Constriction, Pathologic / Q000628:therapy; D003920:Diabetes Mellitus / Q000473:pathology; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000628:therapy; D008297:Male; D008875:Middle Aged; D032389:Myocytes, Smooth Muscle / Q000737:chemistry / Q000166:cytology; D018809:Proliferating Cell Nuclear Antigen / Q000032:analysis* / Q000276:immunology; D006435:Renal Dialysis; D055502:Secondary Prevention; D017539:Tunica Intima / Q000737:chemistry / Q000166:cytology / Q000473:pathology; D014680:Veins / Q000737:chemistry / Q000166:cytology* / Q000473:pathology
D018809:Proliferating Cell Nuclear Antigen