Revascularization procedures are essential for treating cardiovascular disease by restoring the necessary blood flow. For instance, a surgeon may transfer a vein from the leg to the heart to help patients with heart failure. This procedure is also used to create access points for dialysis patients. In such cases, an artery and vein from the arm are commonly connected to allow for blood to be withdrawn, cleaned, and returned to the body. These dialysis access points are called "arteriovenous fistulas" (AVFs), and managing them in patients with end-stage renal disease costs the U.S. healthcare system an estimated USD 5 billion annually. However, the problem is that these revascularization procedures often create the very issue they aim to address: inadequate blood flow. The surgery itself can cause the accumulation of cells in blood vessels, which blocks the blood supply. Repeated surgeries for vascular access and revascularization not only impose a significant burden on patients but also represent a critical gap in medical care.

Now, a nanotechnology-based drug delivery system developed at the University of Virginia Health System (Charlottesville, VA, USA) offers a potential solution to reduce the need for repeated surgeries. This system has demonstrated unexpectedly long-lasting benefits in laboratory tests, which holds promise for its application in human patients. The approach involves applying a paste made of nanoparticles mixed with hydrogel onto transplanted veins to prevent the formation of harmful blockages. These blockages are a common cause of the need for multiple surgeries in heart and dialysis patients, some of whom require numerous procedures on both arms, legs, and even their collarbones to maintain life-saving treatment.

While UVA’s innovation, called "Pericelle," showed promising results in early testing, there were concerns about how long the benefits of this drug delivery method would last. The researchers were hoping the procedure, applied during the initial vein surgery, would continue to protect patients for months afterward. However, even the UVA scientists were surprised by their latest findings, published in Bioactive Materials. Not only did Pericelle work for three months, after the drug supply had been depleted, but it continued to provide benefits at six months and remained effective at nine months. While the scientists cannot fully explain these unexpectedly prolonged benefits, they are encouraged by what this suggests for the potential of the technique. In addition to their work on Pericelle, the UVA team is developing another innovative approach called "epiNanopaint," which would allow surgeons to apply nanoparticles to veins, preventing future clogs and the need for additional surgeries.

“This is a big deal because the treatment could work much longer than we originally thought, far beyond what people would expect,” said researcher Lian-Wang Guo, PhD, who is developing the technique with UVA’s K. Craig Kent, MD. “It is so exciting that one treatment can prevent the harmful blockages for many months. If we can find a way to prevent the need for repeated surgeries, it will have a huge impact on patients' lives.” 

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