Insertion of Short Introducer Sheaths into a Polyurethane Vascular Access Graft for Immediate Hemodialysis Access

Abstract

While native AV fistulae are considered the 'gold standard' for hemodialysis patients in need of long-term access, synthetic grafts are the best option for patients who are not candidates for an AV fistula. While AV fistulae should be allowed to mature for 3 - 4 months prior to cannulation, PTFE grafts may be cannulated 14 days after placement. Despite the benefit of earlier cannulation in PTFE graft recipients compared to AV fistulae patients, one critical limitation is that immediate post-operative cannulation is not possible. The self-sealing nature of the polyurethane Vectra(R) Graft overcomes the time restriction until first cannulation, allowing much earlier vascular access than conventional PTFE grafts. We describe here a procedure for insertion of 5-French DialEasetrade mark Introducer Sheaths into the Vectra Graft for immediate, post-operative hemodialysis access. This procedure eliminates time restrictions until first cannulation of the Vectra Graft; the sheath's large diameter sideport ensures high flow for efficient hemodialysis. Moreover, insertion of the sheath into a new or existing Vectra Graft provides vascular access for inspection of the graft anastomoses, angiography, angioplasty, venography, and declotting procedures. The post-operative introduction of DialEase Sheaths into a Vectra Graft for immediate hemodialysis was successfully performed in 35 patients. All patients then immediately received high-flow hemodialysis (400 - 500 ml) with venous pressures < 125 mmHg and negative arterial pressure ~100 mmHg. To date, there have been no infections, immediate graft thrombosis or other complications associated with this procedure, and all patients have remained free of anastomotic problems. (The Journal of Vascular Access 2003; 4: 62-7).