Abstract No. 431: Early outcomes of the “hybrid” graft used as a conduit for hemodialysis access

Abstract

Achieving functional dialysis access in patients with few or hard to access open deep veins is an ongoing challenge. The development of new technologies may provide an alternative to conventional approaches and maximize the use of the extremity's venous real-estate while reducing the operative insult to these generally fragile patients. We describe our early experience with the hybrid vascular graft (W.L. Gore and Associates, Flagstaff, Ariz.) in 23 patients. The hybrid graft allows for a stented and sutureless distal anastomosis which can be performed using endovascular access. Selection criteria included: no acceptable peripheral alternative access site, previous graft anastomosis or a stent in the venous target at the level of the axilla, failed brachial-basilic upper arm transposition arteriovenous fistula or a target vein < 0.3 cm within the axilla. Patient demographics and early patency were evaluated. Technical success was accomplished in all 23 cases (100%), 7 required a Viabahn (W.L. Gore and Associates, Flagstaff, Ariz.) stent-graft extension and two additional patients percutaneous angioplasty (PTA) to improve venous outflow at the axillary and/or subclavian veins at the time of surgery. Eighteen patients are currently using the hybrid graft, one case of early failure occurred secondary to thrombosis. Two patients recently had the procedure and are not yet using their grafts. 2 patients developed dialysis associated steal syndrome (DASS) requiring plication of the inflow graft segment and one of them also required stenting of the brachial artery to improve inflow. During the follow up period two patients died of comorbidities nonrelated to the access procedure while having a functioning graft. The Hybrid graft concept appears to be a safe and technically effective alternative for patients with a disadvantaged anatomy in whom dialysis access is needed. Long-term data will be required to validate it as a preferential option in patients with limited venous real-estate.