title: Periadventitial drug delivery for the prevention of intimal hyperplasia following open surgery.
abstract: Intimal hyperplasia (IH) remains a major cause of poor patient outcomes after surgical revascularization to treat atherosclerosis. A multitude of drugs have been shown to prevent the development of IH. Moreover, endovascular drug delivery following angioplasty and stenting has been achieved with a marked diminution in the incidence of restenosis. Despite advances in endovascular drug delivery, there is currently no clinically available method of periadventitial drug delivery suitable for open vascular reconstructions. Herein we provide an overview of the recent literature regarding innovative polymer platforms for periadventitial drug delivery in preclinical models of IH as well as insights about barriers to clinical translation.
  
  
  
  A comprehensive PubMed search confined to the past 15years was performed for studies of periadventitial drug delivery. Additional searches were performed for relevant clinical trials, patents, meeting abstracts, and awards of NIH funding.
  
  
  
  Most of the research involving direct periadventitial delivery without a drug carrier was published prior to 2000. Over the past 15years there have been a surge of reports utilizing periadventitial drug-releasing polymer platforms, most commonly bioresorbable hydrogels and wraps. These methods proved to be effective for the inhibition of IH in various animal models (e.g. balloon angioplasty, wire injury, and vein graft), but very few have advanced to clinical trials. There are a number of barriers that may account for this lack of translation. Promising new approaches including the use of nanoparticles will be described.
  
  
  
  No periadventitial drug delivery system has reached clinical application. For periadventitial delivery, polymer hydrogels, wraps, and nanoparticles exhibit overlapping and complementary properties. The ideal periadventitial delivery platform would allow for sustained drug release yet exert minimal mechanical and inflammatory stresses to the vessel wall. A clinically applicable strategy for periadventitial drug delivery would benefit thousands of patients undergoing open vascular reconstruction each year.
authors.affiliation: Department of Surgery, Wisconsin Institute for Medical Research, University of Wisconsin, 1111 Highland Ave, Madison, WI 53705, USA.
authors.forename: Mirnal A
authors.initials: MA
authors.lastname: Chaudhary
authors.affiliation: Department of Surgery, Wisconsin Institute for Medical Research, University of Wisconsin, 1111 Highland Ave, Madison, WI 53705, USA. Electronic address: guo@surgery.wisc.edu.
authors.forename: Lian-Wang
authors.initials: LW
authors.lastname: Guo
authors.affiliation: Department of Surgery, Wisconsin Institute for Medical Research, University of Wisconsin, 1111 Highland Ave, Madison, WI 53705, USA.
authors.forename: Xudong
authors.initials: X
authors.lastname: Shi
authors.affiliation: Department of Materials Science and Engineering, Department of Biomedical Engineering, Wisconsin Institute of Discovery, University of Wisconsin, 330 North Orchard St, Madison, WI 53715, USA.
authors.forename: Guojun
authors.initials: G
authors.lastname: Chen
authors.affiliation: Department of Materials Science and Engineering, Department of Biomedical Engineering, Wisconsin Institute of Discovery, University of Wisconsin, 330 North Orchard St, Madison, WI 53715, USA.
authors.forename: Shaoqin
authors.initials: S
authors.lastname: Gong
authors.affiliation: Department of Surgery, Wisconsin Institute for Medical Research, University of Wisconsin, 1111 Highland Ave, Madison, WI 53705, USA.
authors.forename: Bo
authors.initials: B
authors.lastname: Liu
authors.affiliation: Department of Surgery, Wisconsin Institute for Medical Research, University of Wisconsin, 1111 Highland Ave, Madison, WI 53705, USA; Department of Surgery, University of Wisconsin Hospital and Clinics, 600 Highland Avenue, Madison, WI 53792, USA. Electronic address: kent@surgery.wisc.edu.
authors.forename: K Craig
authors.initials: KC
authors.lastname: Kent
mesh_terms: D063194:Adventitia; D000818:Animals; D016503:Drug Delivery Systems; D006801:Humans; D020100:Hydrogels / Q000008:administration & dosage; D006965:Hyperplasia / Q000473:pathology / Q000517:prevention & control*; D053758:Nanoparticles / Q000008:administration & dosage; D011183:Postoperative Complications / Q000517:prevention & control*; D013514:Surgical Procedures, Operative; D017539:Tunica Intima / Q000473:pathology*
chemical_list: D020100:Hydrogels
keywords: Hydrogel; Intimal hyperplasia; Nanoparticles; Open surgery; Periadventitial drug delivery; Wrap