Adventitial endothelial implants reduce matrix metalloproteinase-2 expression and increase luminal diameter in porcine arteriovenous grafts

Vascular access dysfunction is the leading cause of hospitalization and morbidity in patients receiving hemodialysis for end-stage renal disease. Data indicate that most arteriovenous grafts fail due to the formation of stenosis at the vein-graft anastomotic and venous outflow sites. The stenoses result in luminal narrowing and subsequent graft thrombosis and failure. A satisfactory long-term pharmacologic means of preventing stenosis due to intimal hyperplasia and negative remodeling in hemodialysis grafts has yet to be found. In a large animal model of arteriovenous grafts, we show that placement of an adventitial endothelial implant significantly increased venous lumen diameter at 28 days.