Comparison of Acuseal and Standard ePTFE Vascular Grafts for Hemodialysis: A Retrospective Case Series

Louisa M.S Gerhardt,Regula Marti,Andreas Bock,Stephan Segerer

doi:10.2174/1874303x01912010004

Abstract

Background: Grafts, which allow early cannulation have been increasingly used to avoid starting dialysis via tunneled hemodialysis catheters. As we noted graft failures in patients with early cannulation grafts, we reviewed the outcome of these grafts and compared it to ePTFE grafts. Materials and Methods: We retrospectively analyzed time to first intervention, primary and secondary patency rates as well as the number of interventions needed to maintain patency in patients who received an early cannulation graft (GORE® ACUSEAL, acuseal) or an ePTFE (GORE-TEX®) vascular graft between January 2016 and November 2017 in our medical center. Results: 12 patients who had received an acuseal vascular graft were compared with 13 patients with an ePTFE vascular graft. The mean time to first intervention was similar in both groups. On average 0.33 interventions per graft were needed per month to maintain patency in the acuseal group, and 0.08 in the ePTFE group (p = 0.02). The primary patency rate did not differ significantly between the groups. The secondary patency rate at the end of the observation period was significantly worse in the acuseal group (p = 0.02). Four acuseal grafts were lost after a mean of 202 days, whereas none of the ePTFE grafts was lost. Conclusion: Our data is consistent with our clinical impression of an increased number of interventions and lower longevity of the acuseal vascular graft. These data need conformation in a larger cohort.

Highlights

In recent decades, the dialysis population has changed considerably with a heightened prevalence of diabetes mellitus, an increasing cardiovascular risk and rising age [1]
The native fistula is the vascular access of choice for hemodialysis, but with a changing dialysis population the vascular prerequisites for the formation of native accesses are deteriorating
The two groups did not differ with regards to age, gender, time on hemodialysis and observation time

Summary

Introduction

The dialysis population has changed considerably with a heightened prevalence of diabetes mellitus, an increasing cardiovascular risk and rising age [1]. The native fistula is the vascular access of choice for hemodialysis, but with a changing dialysis population the vascular prerequisites for the formation of native accesses are deteriorating. This construction allows for immediate cannulation and hinders cannulation bleeding. Recent reports about the use of acuseal vascular grafts have shown patency rates in the range of other vascular grafts, but to our knowledge studies comparing the acuseal vascular graft with other vascular grafts are lacking [3, 4]. Grafts, which allow early cannulation have been increasingly used to avoid starting dialysis via tunneled hemodialysis catheters. As we noted graft failures in patients with early cannulation grafts, we reviewed the outcome of these grafts and compared it to ePTFE grafts

Methods

Results

Discussion

Conclusion