2004 Grant Recipient

Cryoplasty to Treat Anastomotic Venous Stenosis

Clayton Trimmer, DO
University of Texas Southwestern Medical School
The majority of synthetic AV dialysis graft failures occur at the venous anastomotic site as a result of intimal hyperplasia. The presence of venous stenosis from intimal hyperplasia decreases flow, increases venous pressures and ultimately reduces the efficiency of the dialysis graft. When left untreated, hemodynamically significant stenoses may lead to complete AV graft thrombosis and eventual shortening of the long-term patency of the graft. Dr. Trimmer's study will examine whether patency following conventional
high pressure balloon angioplasty of the venous anastomosis of a synthetic graft combined with a cryoplasty balloon technique will result in improved three and six-month patency compared with high pressure balloon angioplasty alone. The cryoplasty balloon technique dilates the stenotic lesion and with cold thermal energy induces apoptosis, controls and limits elastic recoil, and theoretically leads to decreased restenosis. This new technique will be evaluated with a prospective randomized human study to test the hypothesis that cryoplasty induced apoptosis can improve patency of synthetic AV grafts.