Early experience with a novel self-sealing nanofabric vascular graft for early hemodialysis access

Aim To report initial experience regarding the use of novel self-sealing electrospun nanofabric graft. Material and methods A total of 21 patients aged between 22 and 64 (male:female ratio = 11:10) underwent AVflo vascular access graft implantation to forearm. Information for patency at 6 and 12 months after the operation was obtained. Cannulation for hemodialysis was allowed 8 h after the operation, as needed. Results Cannulation was performed before 12th hour of implantation in two patients, between 12th and 24th postoperative hours in 10 patients and between 12th and 24th postoperative hours in the remaining nine patients. Primary patency was 17/21 (80.9%) at 6th month and 15/21 (71.4%) at 12th month. Secondary patency was 19/21 (90.4%) at sixth month and 17/21 (80.9%) at 12th month. Conclusion AVflo self-sealing graft allows for early cannulation after implantation and thus may potentially eliminate the need for central venous catheters in selected patients.

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The usefulness and feasibility of placing a clinch knot with a guidewire to achieve temporary hemostasis in arteriovenous dialysis access interventions

The Journal of Vascular Access ◽

10.1177/1129729820954742 ◽

2020 ◽

pp. 112972982095474

Author(s):

Sung-Joon Park ◽

Hwan Hoon Chung ◽

Seung Hwa Lee ◽

Sung Beom Cho ◽

Tae-Seok Seo ◽

...

Keyword(s):

Clinical Success ◽

Primary Patency ◽

Interventional Treatment ◽

Secondary Patency ◽

Dialysis Access ◽

Hemodialysis Access ◽

Purse String Suture ◽

Purse String ◽

Arteriovenous Fistulas ◽

Arteriovenous Grafts

Purpose: To evaluate the usefulness and feasibility of using a reversible clinch knot with a guidewire in place rather than eliminating the access route during an arteriovenous hemodialysis access (AV access) intervention using the facing sheath technique. Material and methods: From July 2016 to June 2019, we retrospectively studied 78 sessions performed as interventional treatment for arteriovenous (AV) hemodialysis (HD) access using the “facing-sheath technique.” In all sessions, all antegrade sheaths were removed while a 0.035-inch guidewire remained in place with purse-string suture and the clinch knot. Seventy-two sessions were performed in patients with thrombosed AV accesses (69 arteriovenous grafts [AVGs] and three arteriovenous fistulas [AVFs]), and six sessions were carried out to treat non-thrombosed AV accesses (four AVGs and two AVFs). We evaluated whether proper hemostasis and successful reinsertion of the sheath over the wire into the clinch knot was achieved. Clinical success was defined as achieving prompt restoration of blood flow for AV access, and the postintervention primary and secondary patency were also evaluated. Result: In all 87 clinch knots created in 78 total sessions, proper hemostasis was achieved. All clinch knots that required reversal for additional procedures were successfully reopened (55 clinch knots in 50 sessions). The postintervention primary patency rates at 1, 3, and 6 months, and at 1 year were 77.8%, 68.9%, 55.6%, and 33.3%, respectively. The postintervention secondary patency rates at 1, 3, and 6 months, and also at 1 year were 93.3%, 91.1%, 86.7%, and 86.7%, respectively. Conclusion: Our AV access intervention which used a clinch knot with purse-string suture while the guidewire remained in place was both useful and feasible for maintaining temporary hemostasis.

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Comparing Outcomes of Upper Extremity Brachiobasilic Arteriovenous Fistulas and Arteriovenous Grafts: A Systematic Review and Meta-Analysis

The Journal of Vascular Access ◽

10.1177/1129729820970789 ◽

2020 ◽

pp. 112972982097078

Author(s):

David J. Haddad ◽

Venkata Sai Jasty ◽

Babu Mohan ◽

Chiu-Hsieh Hsu ◽

Chyi Chyi Chong ◽

...

Keyword(s):

Systematic Review ◽

Upper Extremity ◽

Meta Analysis ◽

Primary Patency ◽

Secondary Patency ◽

Random Effects Model ◽

Hemodialysis Access ◽

Basilic Vein ◽

Arteriovenous Fistulas ◽

Arteriovenous Grafts

Objective: It is unclear what the optimal upper extremity hemodialysis access is for patients without a suitable cephalic vein for arteriovenous fistulas (AVFs). The objective of this systematic review and meta-analysis was to compare the outcomes for upper extremity transposed brachiobasilic AVFs (BBAVFs) and prosthetic arteriovenous grafts (AVGs). Methods: A systematic review was performed to identify all English publications and abstracts comparing the patency outcomes of upper extremity BBAVFs and AVGs (January 1st, 1994 to April 1st, 2020). The outcomes assessed were 1-year and 2-year primary and secondary patency rates. Pooled odds ratios (OR) were calculated using the random-effects model, and I2 statistic was used to assess between-study variability. Results: Twenty-three studies examining 2799 patients were identified and included in the study. The 1-year primary patency rates (OR = 1.68, 95% CI 1.24–2.28, p = 0.001, I2 = 69.40%) and 2-year primary patency rates (OR = 2.33, 95% CI 1.59–3.43, p < 0.001, I2 = 68.26%) were significantly better for BBAVFs than AVGs. Compared to AVGs, the 1-year secondary patency rates (OR = 1.45, 95% CI 1.05–1.98, p = 0.022, I2 = 56.64%) and 2-year secondary patency rates (OR = 1.93, 95% CI 1.39–2.68, p < 0.001, I2 = 57.61%) were also significantly higher for BBAVFs. Conclusion: The outcomes for upper extremity BBAVFs appear to be consistently superior to prosthetic hemodialysis access. This analysis supports the preferential placement of BBAVFs over AVGs in patients with a suitable upper extremity basilic vein.

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

The Journal of Vascular Access ◽

10.5301/jva.5000550 ◽

2017 ◽

Vol 18 (2) ◽

pp. 109-113 ◽

Cited By ~ 6

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.

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Long-Term Outcomes of Staged Basilic Vein Transposition for Hemodialysis Access in Children

The Journal of Vascular Access ◽

10.5301/jva.5000778 ◽

2017 ◽

Vol 18 (5) ◽

pp. 366-370 ◽

Cited By ~ 1

Author(s):

Elias Kfoury ◽

Christopher J. Demaree ◽

Mun J. Poi ◽

Jesus M. Matos ◽

Carlos F. Bechara ◽

...

Keyword(s):

Tertiary Care ◽

Primary Patency ◽

Secondary Patency ◽

Hemodialysis Access ◽

Basilic Vein ◽

Long Term Outcomes ◽

Av Fistula ◽

Functional Maturation

Introduction Children requiring long-term hemodialysis often face significant challenges due to their young age and small-vessel caliber for arteriovenous (AV) access creation. In this study, we report our experience of staged basilic vein transposition (BVT) in pediatric patients. Methods All patients undergoing staged BVT at a tertiary care pediatric hospital from 2003 to 2015 were reviewed. Indications for staged BVT included inadequate cephalic conduit or failed AV fistula using cephalic vein. Pertinent clinical variables were analyzed to determine treatment outcomes. Results Forty-two children (24 males, 57%) underwent 46 staged BVT during the study period. Median age was 12.8 ± 4.8 years (range 3-18). The mean weight was 47 ± 5.1 kg (range, 13-126 kg), with four children (10%) weighing ≤20 kg. Mean operative times for initial brachiobasilic AV fistula and staged BVT were 39 ± 12 minutes and 66 ± 17 minutes, respectively. Mean follow-up period was 5.4 ± 1.8 years. Functional maturation was achieved in 93% of BVTs. Early fistula thrombosis within 30 days following BVT occurred in four patients (10%). Late BVT thrombosis occurred in 13 patients (31%). Primary patency rates at 2 years and 4 years were 78% and 72%, respectively. Secondary patency rates at 2 years and 4 years were 86% and 82%, respectively. Conclusions Staged BVT is a durable and reliable autologous hemodialysis access in children who do not have adequate cephalic venous conduit.

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Increased Risk of Bacteremia in Patients Hemodialyzed Through Central Catheters

Canadian Journal of Infectious Diseases ◽

10.1155/1990/274139 ◽

1990 ◽

Vol 1 (1) ◽

pp. 11-14 ◽

Cited By ~ 1

Author(s):

Geoffrey Taylor ◽

Teresa Kirkland ◽

Peter Hamilton

Keyword(s):

Staphylococcus Aureus ◽

Vascular Grafts ◽

Central Venous Catheters ◽

Hemodialysis Access ◽

Central Venous ◽

Access Site ◽

Prospective Survey ◽

Increased Risk ◽

Central Catheters

As part of an ongoing prospective survey of nosocomial bacteremias, patients developing bacteremia while undergoing in-centre hemodialysis were observed over a 23 month period. Thirty-six episodes of bacteremia occurred in 30 patients: every episode was directly attributable to hemodialysis. In 28 of the 36 episodes (78%), there was evidence of inflammation with or without drainage of pus at the hemodialysis access site.Staphylococcus aureusaccounted for 76% of the bacteremic isolates. Patients hemodialyzing through central venous catheters had a far higher incidence of bacteremia (0.01 per dialysis run) than patients hemodialyzing through vascular grafts (0.0005 per dialysis run).

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Cath-Finder-TM Catheter Tracking System: a new device for positioning of central venous catheters. Early experience from implantation of brachial portal systems

Acta Anaesthesiologica Scandinavica ◽

10.1111/j.1399-6576.1990.tb03089.x ◽

1990 ◽

Vol 34 (4) ◽

pp. 296-300 ◽

Cited By ~ 9

Author(s):

H. Starkhammar ◽

M. Bengtsson ◽

D. A. Kay

Keyword(s):

Tracking System ◽

Early Experience ◽

Central Venous Catheters ◽

Central Venous ◽

Catheter Tracking ◽

New Device ◽

System A

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Primary and secondary patencies of transposed femoral vein fistulas are significantly greater than with the HeRO graft

The Journal of Vascular Access ◽

10.5301/jva.5000697 ◽

2017 ◽

Vol 18 (3) ◽

pp. 232-237 ◽

Cited By ~ 7

Author(s):

Eric D. Ladenheim ◽

Dzenan Lulic ◽

Craig Lum ◽

Sid Agrawal

Keyword(s):

Wound Healing ◽

Femoral Vein ◽

Primary Patency ◽

Secondary Patency ◽

Central Venous ◽

Av Fistula ◽

Central Venous Stenosis ◽

Venous Stenosis ◽

One Year ◽

The One

Introduction For access-challenged patients with bilateral upper extremity central venous stenosis, solutions include the Hemodialysis Reliable Outflow (HeRO) device or an autogenous AV fistula in the lower limb. We evaluated HeRO grafts and transpositions of the femoral vein in maintaining primary and secondary patency. Methods We retrospectively analyzed 40 patients with a HeRO device and 18 patients with superficial femoral artery to transposed femoral vein autogenous arteriovenous fistula (SFA-tFV). All patients had bilateral central venous obstruction. All procedures were outpatient performed by a single surgeon at one center between 2009-2015. Operative details, intraoperative flows, and flows at the first-week postoperative visit were analyzed, as were primary and secondary patency and intervention rates. Complications were compared between groups. Results The one-year cumulative primary patency was 30% for HeRO grafts and 79% for SFA-tFV fistulas (p = 0.0001); secondary patency was 71% for HeRO grafts and 93% for SFA-tFV fistulas (p = 0.03). To maintain patency, HeRO patients required a mean 2.1 interventions per year and thigh fistula patients required a mean 0.4 interventions per year. Thirty-seven percent of thigh fistula patients had a hematoma or seroma versus 5% of HeRO patients and 17% of thigh fistula patients experienced delayed wound healing versus 2.5% of HeRO patients (p<0.05). None of the thigh fistula patients had distal ischemia. Conclusions HeRO patients had lower primary and secondary patency rates versus thigh fistula patients and HeRO grafts required five-fold more interventions to maintain secondary patency. However, patients with thigh fistulas had significantly more wound healing problems. Thus, the SFA-tFV has become our access of choice for patients with bilateral central venous stenosis.

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Challenges of Hemodialysis Access for High Risk Patients: Impact of Mesenteric Vein Bioprosthetic Graft

The Journal of Vascular Access ◽

10.1177/112972980300400208 ◽

2003 ◽

Vol 4 (2) ◽

pp. 73-80 ◽

Cited By ~ 10

Author(s):

M.H. Glickman ◽

J.H. Lawson ◽

H.E. Katzman ◽

A.F. Schild ◽

R.M. Fujitani

Keyword(s):

High Risk ◽

African Americans ◽

Patency Rate ◽

Primary Patency ◽

Secondary Patency ◽

Hemodialysis Access ◽

Primary Patency Rate ◽

Risk Patients ◽

History Of

Objective The purpose of this study is to compare in a prospective fashion the performance of a new bioprosthesis, the mesenteric vein bioprosthesis (MVB), in patients who have had multiple failed ePTFE grafts. Performance measures include primary patency rates, assisted-primary patency rates, secondary patency rates, complications, and the number of interventions required to maintain graft patency. Study: From October 1999 to February 2002, 276 hemodialysis access grafts were implanted in a multicenter study. Of those grafts, 74 were placed in patients with a prior history of ≥ 3 failed prosthetic grafts (mean = 3.5 grafts, range = 3–6 grafts). Fifty-nine grafts were constructed with MVB, and 15 grafts with ePTFE as a concomitant control. Mean follow-up was 11.5 months. In the MVB group, 79.7% were African-Americans, 61% were females, and 23.7% were hypercoagulable. Of the ePTFE group, 86.7% were African-Americans, 46.7% were female, and 13.2% were hypercoagulable. Results Per Kaplan-Meier curves, the primary patency rate of the MVB group at 12 months was 33% vs the ePTFE group of 18% (p=0.120); the assisted-primary patency rates at 12 months were 45% MVB vs 18% ePTFE (p=0.011). The secondary patency rates at 12 and 24 months for the MVB group were 67% and 59%, respectively, vs 45% and 15% for the ePTFE group (p=0.006). During the follow-up time period, 80% of the ePTFE grafts were abandoned compared to 34% of the MVB group. Infection and thrombosis rates in the MVB group were lower than the ePTFE group. The infection rate for the MVB group requiring intervention was 0.07 events/graft year (gt/y) compared to 0.30 events/gt-y for ePTFE (p=0.04). A thrombosis rate of 0.69 events/gt-y occurred in the MVB group whereas 2.50 events/gt-y presented in the ePTFE group (p<0.01). Conclusion: In this study, high-risk patients (defined as those having multiple failed prosthetic grafts for hemodialysis) in whom the MVB conduit for hemoaccess was implanted, showed significant improvement in assisted-primary and secondary patency rates compared to the ePTFE cohort. The MVB group, however, did not have a statistically better primary patency rate compared to the ePTFE group. The MVB patient also had fewer thrombotic and infectious events and an overall reduction in the number of interventions while maintaining a permanent access site. This new bioprosthesis should be the conduit of choice in the complex group of patients as it offers assisted-primary and secondary patency rates similar to those commonly experienced by patients without a history of multiple graft failures.

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

Indian Journal of Medical Research and Pharmaceutical Sciences - September-2020 ◽

10.29121/ijmrps.v7.i8.2020.1 ◽

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.

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