Short- to midterm results of early cannulation arteriovenous grafts (Gore® ACUSEAL) for hemodialysis: Experience with the ACUSEAL in a Japanese cohort

2020 ◽  
pp. 112972982097425
Author(s):  
Kenichi Honma ◽  
Daihiko Eguchi
Keyword(s):  
Graft Infection ◽  
Prosthetic Graft ◽  
Skin Incision ◽  
Primary Patency ◽  
Outer Diameter ◽  
Secondary Patency ◽  
Complication Rates ◽  
Japanese Cohort ◽  
Surgical Wounds ◽  
Steal Syndrome

Background: In patients without suitable vasculature for autologous arteriovenous fistula, vascular access using a prosthetic graft is an option for hemodialysis. Gore® ACUSEAL Vascular graft is an early cannulation arteriovenous graft (AVG) that allows early puncture within 24 h after surgery. We aimed to report the outcomes of using this graft in patients from a single center. Methods: This study included 113 patients who underwent surgery for a new AVG using ACUSEAL, between December 2015 and December 2017, and were followed up. The primary outcomes were primary patency, assisted-primary patency, and secondary patency. Secondary outcomes were postoperative complications such as graft infection and steal syndrome. Results: Of the 113 patients, 60 were male and 53 were female. The average age was 74.4 ± 10.7 years. We could cannulate 69.1% of patients within 24 h. The average follow-up period was 20.1 ± 10.8 months. The primary patency rates after 3 months, 6 months, and 1 year were 76.2%, 60.4%, and 33.8%, respectively. The assisted-primary patency rates after 3 months, 6 months, and 1 year were 88.8%, 73.2%, and 58.9%, respectively. The secondary patency rates after 3 months, 6 months, and 1 year were 100%, 100%, and 98.8%, respectively. Fourteen patients (12.4%) developed graft infection and two patients (1.8%) developed steal syndrome. Conclusion: In our study, ACUSEAL showed satisfactory patency and acceptable complication rates in the short to medium term, similar to previous studies. ACUSEAL is beneficial for surgeons who are familiar with using AVG and for medical staff who control bleeding after dialysis. However, due to the large outer diameter of the graft, surgical wounds might become dehiscent, and careful designing of the subcutaneous graft route is necessary. It might be possible to reduce the rate of graft infection by planning the site and skin incision.

Early cannulation graft Flixene™ for conventional and complex hemodialysis access creation

2017 ◽  
Vol 18 (2) ◽  
pp. 109-113 ◽  
Author(s):  
Carlos A. Hinojosa ◽  
Saul Soto-Solis ◽  
Sandra Olivares-Cruz ◽  
Hugo Laparra-Escareno ◽  
Zeniff Gomez-Arcive ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Primary Patency ◽  
Secondary Patency ◽  
Ptfe Graft ◽  
Complication Rates ◽  
Hemodialysis Access ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients ◽  
Steal Syndrome

Purpose The Flixene™ (Atrium™, Hudson, NH) is a trilaminate composite polytetrafluoroethylene (PTFE) graft that allows access within 72 hours. We evaluate our initial experience with this device for conventional and complex hemodialysis access creation. Methods Retrospective review in end-stage renal disease (ESRD) patients who underwent access creation with Flixene from January 2013 to July 2014. For our analysis, the patients were divided in two groups: those with complex access configurations tunneled in the chest and/or abdominal wall (thoraco-abdominal wall access [TAWA]), and those tunneled in conventional sites (extremity access [EA]). Patient's demographics, indications, complications, reinterventions, patency rates and factors influencing outcomes were evaluated. Results In 19 patients (54% men; mean age 44 years ± 18), 24 grafts were implanted, (13 EA [54%] vs. 11 TAWA), all patent after surgery. Central venous occlusive disease (CVOD) was present in all patients with TAWA and in 7/13 (54%) EA patients (p = 0.016). Early cannulation (within 72 hours) was successful in 12 EA and 5 TAWA grafts (p = 0.044). Complication rates including infection, thrombosis, bleeding and steal syndrome were 8/11 (73%) in TAWA and 5/13 (38%) in EA (p = 0.02). At 12 months, primary patency rates for EA and TAWA were 25% and 41%; secondary patency rates were 55% and 41%, respectively. Conclusions Early cannulation (EC) grafts are viable alternatives for conventional and complex access creation that allowed early cannulation (<72 hours) in 17 (70%) of our cases. Primary and secondary patency rates at 12 months were equivalent to data reported on ePTFE grafts.

MILLER Banding Procedure for Treatment of Dialysis Access–Related Steal Syndrome, Pulmonary Hypertension, and Heart Failure

2021 ◽  
pp. 000313482110562
Author(s):  
Ahmad Alqassieh ◽  
Patrick B. Dennis ◽  
Veena Mehta ◽  
June Shi ◽  
Angello Lin ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Vascular Access ◽  
Primary Patency ◽  
Secondary Patency ◽  
Dialysis Access ◽  
Long Term Follow Up ◽  
Steal Syndrome

A Minimally Invasive Limited Ligation Endoluminal-assisted Revision (MILLER) banding procedure has been used for treating patients with dialysis access–related steal syndrome (DASS) and high-flow vascular access–related pulmonary hypertension (PHT) and heart failure (HF). We performed a retrospective analysis of patients undergoing the MILLER procedure performed for DASS, HF, and PHT from our Vascular Access Database from September 2017 to October 2019. Outcomes included primary patency of banding, primary assisted patency, and secondary patency, using time-to-event analyses with Kaplan-Meier curves and life tables to estimate 6- and 12-month rates. A total of 13 patients (6 men and 7 women, mean age 60 ± 14 years) underwent the MILLER procedure, 6 patients for DASS and 7 patients for pulmonary hypertension and heart failure (PHT/HF). Technical success was achieved in all patients. The longest duration of follow-up was 28 months (median 12 months [IQR 7, 19]). One patient died at 1 month after the intervention due to stroke. One patient developed access thrombosis of the graft 3 days after the procedure. Repeat banding was required in 1 patient 8 months after the first procedure. The 6-month primary patency rate of banding following this procedure was 83% while the 12-month rate was 66%. The 6- and 12-month secondary patency rates were 87% and 75%, respectively. The MILLER procedure can be performed for DASS and PHT/HF with improvement of symptoms and good long-term patency rates. Additional interventions to maintain patency and efficacy are required on long-term follow-up.

Tapered and non-tapered prosthetic grafts in upper extremity dialysis access: A systematic review and meta-analysis

2020 ◽  
pp. 112972982097417
Author(s):  
Venkata Sai Jasty ◽  
David Haddad ◽  
Babu Mohan ◽  
Wei Zhou ◽  
Jeffrey J Siracuse ◽  
...  
Keyword(s):  
Systematic Review ◽  
Upper Extremity ◽  
Meta Analysis ◽  
Primary Patency ◽  
Secondary Patency ◽  
Dialysis Access ◽  
Significant Difference ◽  
Arteriovenous Grafts ◽  
Meta Analyses ◽  
Steal Syndrome

Objective: It is unclear whether tapered arteriovenous grafts (AVGs) are superior to non-tapered AVGs when it comes to preventing upper extremity ischemic steal syndrome. We aimed to evaluate the outcomes of tapered and non-tapered AVGs using systematic review and meta-analysis. Methods: A literature search was systemically performed to identify all English publications from 1999 to 2019 that directly compared the outcomes of upper extremity tapered and non-tapered AVGs. Outcomes evaluated were the primary patency at 1-year (number of studies ( n) = 4), secondary patency at 1-year ( n = 3), and risk of ischemic steal ( n = 5) and infection ( n = 4). Effect sizes of individual studies were pooled using random-effects model, and between-study variability was assessed using the I2 statistic. Results: Of 5808 studies screened, five studies involving 4397 patients have met the inclusion criteria and included in the analysis. Meta-analyses revealed no significant difference for the risk of ischemic steal syndrome (pooled odds ratio (OR) 0.92, 95% Confidence Incidence (CI) 0.29–2.91, p = 0.89, I2 = 48%) between the tapered and non-tapered upper extremity AVG. The primary patency (OR 1.33, 95% CI 0.93–1.90, p = 0.12, I2 = 10%) and secondary patency at 1-year (OR 1.49, 95% CI 0.84–2.63, p = 0.17, I2 = 13%), and rate of infection (OR 0.62, 95% CI 0.30–1.27, p = 0.19, I2 = 29%) were also similar between the tapered and non-tapered AVG. Conclusions: The risk of ischemic steal syndrome and patency rate are comparable for upper extremity tapered and non-tapered AVGs. This meta-analysis does not support the routine use of tapered graft over non-tapered graft to prevent ischemic steal syndrome in upper extremity dialysis access. However, due to small number of studies and sample sizes as well as limited stratification of outcomes based on risk factors, future studies should take such limitations into account while designing more robust protocols to elucidate this issue.

Single-centre experience with endovascular rotational thrombectomy for single session salvage of thrombosed arteriovenous fistulas and grafts

2021 ◽  
pp. 112972982110609
Author(s):  
Cheryl Lim ◽  
Justin Kwan ◽  
Zhiwen Joseph Lo ◽  
Qiantai Hong ◽  
Li Zhang ◽  
...  
Keyword(s):  
Vascular Access ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Primary Patency ◽  
Secondary Patency ◽  
Complication Rates ◽  
Single Session ◽  
Arteriovenous Fistulas ◽  
Rotational Thrombectomy ◽  
Thrombectomy Device

Objectives: This paper documents our experience and outcomes of using a relatively new endovascular rotational thrombectomy device for salvage of thrombosed vascular access. Methodology: A retrospective study reviewing patients with thrombosed native AVF or AVG who underwent endovascular declotting using a rotational thrombectomy device between November 2018 and May 2020 at a tertiary university hospital in Southeast Asia. We evaluated demographics, procedural data, technical and procedural success, patency rates and complications. Results: A total of 40 patients underwent single session endovascular declotting of thrombosed vascular access. The mean follow-up period was 21.6 months (range 13.4–31 months). The technical success was 92.5% and clinical success was 80%. About 50% of patients had concomitant thrombolysis for pharmacomechanical thrombectomy. One patient had a myocardial infarction during the post-operative period. There were no other major complications within 30 days. The primary patency was 45.5% at 6 months and 22.7% at 12 months. Assisted primary patency was 68.1% at 6 months and 61.6% at 12 months, which was maintained up to 2 years. The secondary patency was 84.1% at 6 and 12 months. Conclusion: Our study shows that rotational thrombectomy device for single session thrombectomy of thrombosed arteriovenous fistulas and grafts is safe and effective. A high technical and clinical success rate was achieved, with low complication rates and specific advantages compared to other techniques, including reduced length of hospital stay. Our reported mid-term outcomes are reasonable with an assisted primary patency of 62% at 12 and 24 months. The use of newer techniques and novel dedicated thrombectomy devices show promise.

Prosthetic Arteriovenous Grafts for Hemodialysis

2009 ◽  
Vol 10 (3) ◽  
pp. 137-147 ◽  
Author(s):  
Jacob A. Akoh
Keyword(s):  
Graft Infection ◽  
Fold Increase ◽  
Graft Patency ◽  
Secondary Patency ◽  
Av Fistula ◽  
Full Physical Examination ◽  
Anastomotic Angle ◽  
Steal Syndrome ◽  
Av Graft

Introduction Prosthetic arteriovenous (AV) grafts are indicated in patients with failed AV fistula (AVF), exhausted superficial veins or unsuitable vessels. Increasing the proportion of prevalent hemodialysis (HD) patients using autogenous AVF should reduce the need for AV grafts and associated morbidity. This paper reviews the current role of prosthetic AV grafts in vascular access for HD. Technical considerations Prior to the insertion of a prosthetic AV graft, a comprehensive review of previous access procedures and full physical examination in addition to vessel mapping is required. Anastomotic technique should take into account the flow diffuser concept, graft geometry and an anastomotic angle of 15° in order to reduce the incidence of intimal hyperplasia. Results Many authors report 1 and 2-yr cumulative graft patency rates of 59–90% and 50–82%, respectively. The major drawbacks with synthetic grafts include: thrombosis, a five-fold increase in infection risk and steal syndrome. The choice between surgical and percutaneous methods of dealing with blocked AV grafts remains controversial, though percutaneous techniques are assuming an increasingly important role. Percutaneous strategies are successful in declotting access in 67–95% of cases. Stenting of stenotic lesions following thrombectomy improves secondary patency rates. Strategies for dealing with AV graft infection include antibiotic prophylaxis, partial, subtotal or total graft excision and the use of biological prosthesis. Conclusions Though more prone to complications than autogenous AVFs, AV grafts offer a short maturation period and are more amenable to thrombectomy by radiological or surgical means. Complex AV grafts may be appropriate in patients with exhausted access sites.

Clinical Impact of Intravascular Ultrasound Guidance During Endovascular Treatment of Subclavian Artery Disease

2017 ◽  
Vol 24 (5) ◽  
pp. 731-738 ◽  
Author(s):  
Wen-Jung Chung ◽  
Yoshimitsu Soga ◽  
Yusuke Tomoi ◽  
Masahiko Fujihara ◽  
Shinya Okazaki ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Endovascular Treatment ◽  
Intravascular Ultrasound ◽  
Subclavian Artery ◽  
Primary Patency ◽  
Secondary Patency ◽  
Complication Rates ◽  
All Cause Mortality ◽  
Artery Disease

Purpose: To evaluate the short- and long-term efficacy of intravascular ultrasound (IVUS) guidance during endovascular treatment (EVT) of subclavian artery disease. Methods: The multicenter SCALLOP registry (SubClavian Artery disease treated with endovascuLar therapy; muLticenter retrOsPective registry) was interrogated to identify 542 patients who underwent successful EVT for SCAD between January 2003 and December 2012. Lesions were classified according to the use of IVUS guidance: 177 patients (mean age 68.9±8.6 years; 149 men) with and 373 patients (mean age 69.9±8.7 years; 275 men) without. The main outcome was the difference in primary patency; secondary outcomes were differences in assisted primary patency, secondary patency, overall survival, freedom from major adverse cardiovascular events [MACE; all-cause mortality, myocardial infarction (MI), and stroke], and freedom from major adverse events (MAE). Multivariate analysis of the IVUS+ group was performed to identify predictors of failure; results are presented as the hazard ratio (HR) and 95% confidence interval (CI). Results: In total, 538 (97.8%) lesions were treated with stents and 12 lesions by balloon angioplasty alone. Periprocedural and in-hospital overall complication rates did not differ significantly between IVUS+ (10.2%) and IVUS– (8.8%, p=0.617). Long-term follow-up demonstrated no significant difference between IVUS+ and IVUS– groups in 5-year all-cause mortality (p=0.37), MI (p=0.07), stroke (p=0.31), or MACE (p=0.07). However, 5-year primary patency was significantly higher in the IVUS+ group (88.5% vs 77.7%, p=0.03). There were no group differences in 5-year assisted primary patency (90.4% vs 89.9%, p=0.81) or secondary patency (99.4% vs 97.1%, p=0.25). Multivariate analysis of the IVUS+ group identified in-hospital stroke (HR 16.92, 95% CI 3.60 to 79.42, p<0.01) and combined use of balloon-expandable and self-expanding stents (HR 5.59, 95% CI 1.22 to 25.65, p=0.02) as independent negative predictors of primary patency. Conclusion: These results suggest that IVUS guidance can significantly improve long-term primary patency following endovascular treatment of subclavian artery disease.

Forearm versus upper arm grafts for vascular access

2017 ◽  
Vol 18 (1_suppl) ◽  
pp. S77-S81
Author(s):  
Shawn M. Gage ◽  
Jeffrey H. Lawson
Keyword(s):  
Clinical Success ◽  
Ulnar Artery ◽  
Primary Patency ◽  
Secondary Patency ◽  
Arteriovenous Graft ◽  
Potential Complication ◽  
Upper Arm ◽  
Operative Planning ◽  
Arteriovenous Grafts ◽  
Steal Syndrome

Forearm and upper arm arteriovenous grafts perform similarly in terms of patency and complications. Primary patency at 1 year for forearm arteriovenous grafts versus upper arm grafts ranges from 22%-50% versus 22%-42%, and secondary patency at 1 year ranges from 78%-89% versus 52%-67%), respectively. Secondary patency at 2 years, ranges from 30%-64% versus 35%-60% for forearm and upper arteriovenous graft, respectively. Ample pre-operative planning is essential to improved clinical success and the decision to place a graft at one location versus the other should be based solely on previous access history, physical exam, appropriate venous imaging, and other factors that make up the clinical picture. Operative implant strategies and risk of complications are very similar between the two configurations. Postoperative ischemia due to steal syndrome is a potential complication that requires immediate attention. Utilization of the proximal radial or ulnar artery for inflow for the graft can minimize risk of clinically relevant steal syndrome.

OUTCOMES OF ARTERIOARTERIAL PROSTHETIC LOOP GRAFT AS AN ALTERNATIVE HEMODIALYSIS ACCESS.

2020 ◽  
Vol 7 (8) ◽  
pp. 1-8
Keyword(s):  
Graft Infection ◽  
Anterior Chest Wall ◽  
Primary Patency ◽  
The Body ◽  
Secondary Patency ◽  
Hemodialysis Access ◽  
Graft Thrombosis ◽  
Multi Access ◽  
Stage Renal Disease ◽  
End Stage

Objective: to describe the technique and study the safety and efficacy of arterioarterial prosthetic loop graft as a hemiodialysis access option in multi-access failure patients. Methods:This is a retrospective single center study which was conducted at the vascular surgery department in KHMC. Data of patients who underwent arterioarterial loop graft in the period between January 2014 and January 2019 was collected and analyzed. Results: 23 patients underwent the procedure. 18 patients underwent anterior chest wall axilloaxillary arterial loop graft while 5 patients underwent arterioarterial loop graft based of the superficial femoral artery (SFA). The primary patency rates at 6, 12, and 18 months were 91.3%, 74%, and 61% respectively. The secondary patency rates at 6, 12, and 18 months were 95.6%, 82.6%, and 78.3% respectively. Three patients developed localized graft infection at the site of puncture. Two patients developed false aneurysms in the body of the graft. 0ne patient developed limb threatening ischemia secondary to graft thrombosis. There was no procedure related mortality. Conclusions: Prosthetic arterioarterial loop graft is a safe and effective hemodialysis access option in carefully selected subsets of end stage renal disease patients.

One- versus two-stage transposed brachiobasilic arteriovenous fistulae: A review of the current state of the art

2019 ◽  
Vol 21 (3) ◽  
pp. 281-286 ◽  
Author(s):  
Mohamed Sheta ◽  
Jalal Hakmei ◽  
Mark London ◽  
Mathew Wooster ◽  
John Aruny ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Primary Patency ◽  
Secondary Patency ◽  
Search Term ◽  
Complication Rates ◽  
Basilic Vein ◽  
Two Stage ◽  
Pubmed Search ◽  
Adequate Quality ◽  
Student’S T

In the absence of suitable cephalic vein, the brachiobasilic vein complex represents the best option for arteriovenous access. However, the basilic vein is too deep to cannulate and requires transposition to be accessible. Transposition can be performed during fistula creation (single-stage BBTx) or at a second operation after initial fistula creation (two-stage brachiobasilic transposition (BBTx)). The best approach is unknown. A PubMed search using “Basilic vein transposition” as the primary search term was performed to identify articles addressing this controversy. Meta-analysis was then performed using those papers that provided the inspected data points with student’s t-test used to compare maturation and patency rates between the groups. A total of 37 manuscripts were judged of adequate quality for analysis. Based on the available data, overall maturation rates, 1-year primary patency rates, and overall complication rates seem to be equivalent between single- and two-stage BBTx, while 1-year secondary patency is greater in the two-stage group (79% vs 85%). A large prospective randomized clinical trial with clear definitions of maturity, patency, and complications is needed to definitively answer the question of whether one strategy is better than the other.

A retrospective review of basilic and cephalic vein-based fistulas

Vascular ◽  
2011 ◽  
Vol 19 (2) ◽  
pp. 97-104 ◽  
Author(s):  
Anantha K Ramanathan ◽  
Nader D Nader ◽  
Maciej L Dryjski ◽  
Hasan H Dosluoglu ◽  
Gregory S Cherr ◽  
...  
Keyword(s):  
Retrospective Review ◽  
Primary Patency ◽  
Cephalic Vein ◽  
University Hospital ◽  
Secondary Patency ◽  
Complication Rates ◽  
Basilic Vein ◽  
Maturation Time ◽  
Hospital System

This study compares outcomes of basilic and cephalic vein fistulas for hemodialysis. A retrospective review of arteriovenous fistulas in a university hospital system was performed using charts and hemodialysis records. Patency and demographic data were assessed with life table analysis. One hundred fifty-six patients (88 males; 68 females) underwent creation of 172 autogenous fistulas (mean age 61 years; mean follow-up 78 weeks). There were 101 basilic vein transpositions and 71 cephalic vein fistulas. Primary patency did not differ significantly, while assisted primary patency was significantly better for basilic vein fistulas at one year (73% versus 53%: P = 0.024). Secondary patency was significantly better for basilic fistulas through three years (58% versus 52%; P = 0.027). Primary failure (thrombosis before access or failed maturation) was significantly higher for cephalic than basilic fistulas (28% versus 13%; P = 0.01). Maturation time, usage time and complications were not significantly significant. Thirty-three (33%) basilic vein-based fistulas and 12 (17%) cephalic vein fistulas required revision during follow-up. Basilic vein-based fistulas perform as well as or better than cephalic vein-based fistulas in terms of patency, maturation time, and usage time and complication rates, though requiring more re-interventions.

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