Misra S et al. (2006) BRAVO I: a pilot study of vascular brachytherapy in polytetrafluoroethylene dialysis access grafts. Kidney Int 70: 2006–2013

Hemodialysis vascular access dysfunction, which causes considerable morbidity, often results from venous stenosis followed by thrombosis in polytetrafluoroethylene (PTFE) grafts. Vascular brachytherapy (endovascular radiation therapy) has shown promise for the prevention of coronary restenosis, but there are few data on its use for hemodialysis vascular access stenosis.

The BRAVO I pilot trial randomized 25 patients with nonthrombosed (patent) but dysfunctional PTFE dialysis access grafts to radiation (18.4 Gy single dose; n = 14) or sham radiation (n = 11) after angioplasty. Patients were followed up monthly from their first post-angioplasty hemodialysis session and underwent an angiogram at 6 months.

Baseline demographics were similar between groups. At the 6-month angiogram, primary patency of the target lesion (i.e. no access thrombosis or need for intervention within the treatment area) was achieved by 41.6% of radiation-treated patients compared with 0% of the sham radiation group (P = 0.015). Secondary patency (i.e. vascular access not abandoned or surgically revised) at 6 months was similar in the two groups (about 90%), although more interventions were needed to achieve secondary patency in the sham group. Thrombosis rates were similar in the two groups. During screening, treatment or follow-up, four complications occurred in 88 interventional procedures. Adverse events were mainly a result of comorbidities present in hemodialysis patients. Blood flow through grafts improved in the radiation group but declined in the sham group.

The authors conclude that vascular brachytherapy might show promise for patients with dysfunctional dialysis access grafts, but state that larger studies are needed.