Vascular brachytherapy for hemodialysis vascular XXXX : exploring an unmet clinical need.

@entity1 @entity736 @entity409 @entity715 @entity1211
Hemodialysis vascular @entity409 is a major cause of morbidity and hospitalization in the hemodialysis population (230,000 @entity1 in the United States) at a cost of well over 1 billion dollars per annum. @entity1211 and @entity715 (due to @entity1211 ), is the most common cause of hemodialysis vascular @entity409 . At the clinical level, this manifests in the form of a 50%, one-year primary patency for new grafts, and a dismal 40% 3-month survival for thrombosed grafts. However, despite the magnitude of the clinical problem, there are currently no effective therapies for this condition. We and others have previously demonstrated that @entity1211 in @entity736 ( @entity736 ) dialysis grafts is composed of smooth muscle cells/myofibroblasts, a perigraft macrophage layer and microvessels within the @entity1211 . Interestingly, there is strong experimental evidence which demonstrates that radiation therapy blocks the proliferation and activation of all these cell types. In addition, endovascular radiation therapy has already been successfully used to prevent restenosis following coronary angioplasty. The BRAVO trial is a randomized, multi-center, double-blind clinical trial of endovascular radiation in PTFE dialysis grafts, sponsored by the Novoste Corporation. This trial is particularly significant as it is the first large multi-center study that is focused on testing a novel local intervention in the specific setting of dialysis @entity409 . The rationale behind this study, and its design and the logistics involved, will also be described in this review.
