Inside access
Researchers’ key takeaways:
1 Endovascular AV fi stula creation is a minimally
invasive procedure with an excellent technical success rate and should be encouraged in more institutions.
2 High cumulative and functional patency
with endovascular AV fi stulas using the WavelinQ device.
3 We found a very low complication rate,
allowing for a safe and secure procedure for our patients.
4 We encourage more prospective studies to be
done and collaboration in multi-centers for improved patient care.
are not surgical candidates due to other comorbidities are now offered a minimally invasive approach for hemodialysis fistula creation without surgery. Nevertheless, further studies should be encouraged to support our findings, shifting the current surgical avenue into the new and more appealing endovascular avenue.
What are the next steps? Any additional research planned? EK: Our goal is to seek long-term functional and cumulative patency for endovascular AV fistula creation as well as join forces with other institutions, making a bigger cohort study. To become gold standard, more publications are needed for the sake of education and results transparency.
Double-balloon, catheter-mediated transarterial chemotherapy delivery in a swine model: A mechanism recruiting the vasa vasorum for localized therapies
Farsad K, Novelli PM, Laing C, Gandhi RT, Cynamon J, López CS, Stempinski ES, Strasser R, Agah R.
Tell us about yourself, your research team and institution. Khashayar Farsad, MD, PhD: I am currently interim chair of interventional radiology at Oregon Health and Science University and director of the Dotter Interventional Institute. As the birthplace of interventional radiology, we take a lot of pride in our history of research and innovation and are looking to carry this forward with the ongoing evolution of IR as a specialty. Our research program has a focus on cancer therapies, portal hypertension and vascular disease. Complementing our clinical trials program, we have translational models that we hope will help inform future bench-to-bedside clinical trials. Historically, our department has focused on medical device development, and our more recent models are helping to drive newer therapeutic opportunities for cancer and venous disease.
What was the focus of your study? KF: This study aimed to better understand the mechanism of drug delivery for the RenovoCath catheter by RenovoRx (Los Altos, CA). The catheter is currently being used in a phase III multicenter international randomized controlled clinical trial (NCT03257033). We assessed the benefi t of intra- arterial gemcitabine delivery using the RenovoCath catheter compared to standard-of-care IV gemcitabine for locally advanced pancreatic adenocarcinoma. The intra-arterial treatments have shown promise for improved outcomes in earlier phases of the trial; RenovoRx was interested in better understanding the mechanism of drug delivery as it is somewhat unique relative to existing transarterial treatment paradigms. For example, the mode of treatment for RenovoCath does
not use tumor-feeding arteries akin to typical embolotherapies. By contrast, the treatment paradigm is based on transmural passage of a drug across the arterial wall and directly into the tumor-infi ltrating tissues. I think of it as conceptually more similar to a direct tumor injection of drug rather than delivery via the tumor blood supply. The study was designed to better understand the eff ect of drug delivery with this catheter by using gemcitabine, gold nanoparticles and dyes to assess tissue infi ltration.
Why did you set out to research this topic? KF: RenovoRx reached out to our lab to collaborate on this project. Since we were a site for the clinical trial, we were interested in helping better understand how this catheter functions for drug delivery. Certain aspects of how the catheter functioned were unknown, including what happens to the intra-arterial pressure during delivery, and by what means the drug is passing through the arterial wall to penetrate the surrounding perivascular tissues. For example, we observed that clinical outcomes with intra-arterial therapy for pancreatic cancer were better after tissue radiation. But it is unknown whether this was simply a result of “leakier” blood vessels related to alterations in cell–cell connections, defects in the basement membrane, infl uences of the peritumoral lymphatics and venules, or from some other mechanism.
What were the key takeaways? KF: Through this study, we were able to identify the vasa vasorum as likely one of the primary means of transmural drug delivery based on the localization of gold nanoparticles by
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