A Novel Electrospun Nano-fabric Graft Allows Early Cannulation Access and Reduces Exposure to Central Venous Catheters

Abstract

Purpose

The use of tunneled central venous catheters (CVC) as vascular access for hemodialysis treatment is increasing worldwide. We present a novel polycarbonate urethane nano-fabric graft, produced by electrospinning technology, which has self-sealing features that avoid seroma formation and allow puncturing within 48 hours. The aim of this study was to assess its advantages in a setting where late referral is common.

Methods

A retrospective single center study assessed 24 implanted grafts in 24 patients with maximal follow-up of 18 months; patency rates, time to first cannulation and post-operative complications were assessed.

Results

Successful access was achieved in all 24 patients within 48 hours. In 50% of the patients cannulation was performed within 24 hours without increasing the complication rate. Twelve month primary and secondary patencies were 50% and 70.8%, respectively. Excluding early failures (within 30 days) because of surgical problems, 12 month primary and secondary patencies were 75% and 81.2% respectively. Complication and infection rates were 10.94 and 0.49/1000 dialysis procedures, respectively. No pseudoaneurysms or seromas were documented at 18 months.

Conclusions

Early cannulation was successful in all patients with good 12-month primary and secondary patency rates, compared to data reported by others on polytetrafluoroethylene (PTFE) grafts. The infection rate was substantially lower than in tunneled CVCs. Therefore, the AVflo graft may improve the clinical status of dialysis patients by decreasing the exposure to CVCs.

Keywords

Arterio-Venous-Access Clinical study Early access Electrospinning Hemodialysis graft Nano-fabric Polycarbonate urethane

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References

Ethier

, Mendelssohn

D.C.

, Elder

S.J.

Vascular access use and outcomes: an international perspective from the Dialysis Outcomes and Practice Patterns Study. Nephrol Dial Transplant. 2008; 23 (10): 3219–3226.

Wijeyaratne

S.M.

, Kannangara

Safety and efficacy of electrospun polycarbonate-urethane vascular graft for early hemodialysis access: first clinical results in man. J Vasc Access. 2011; 12 (1): 28–35.

Slayden

G.C.

, Spergel

, Jennings

W.C.

Secondary arteriovenous fistulas: converting prosthetic AV grafts to autogenous dialysis access. Semin Dial. 2008; 21 (5): 474–482.

Sidawy

A.N.

, Gray

, Besarab

Recommended standards for reports dealing with arteriovenous hemodialysis accesses. J Vasc Surg. 2002; 35 (3): 603–610.

KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for 2006 Updates: Hemodialysis Adequacy, Peritoneal Dialysis Adequacy and Vascular Access. Am J Kidney Dis 2006; 48 (Suppl 1): S1–S322. Also available at: http://www.kidney.org/professionals/kdoqi/pdf/12-50-0210JAG_DCP_Guidelines-VA_Oct06_SectionC_ofC.pdf.

Brescia

M.J.

, Cimino

J.E.

, Appel

, Hurwich

B.J.

Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula. N Engl J Med. 1966; 275 (20): 1089–1092.

Tordoir

, Canaud

, Haage

EBPG on vascular access. Nephrol Dial Transplant. 2007; 22 (Suppl 2): ii88–ii117.

Biuckians

, Scott

E.C.

, Meier

G.H.

, Panneton

J.M.

, Glickman

M.H.

The natural history of autologous fistulas as first-time dialysis access in the KDOQI era. J Vasc Surg. 2008; 47 (2): 415–421, discussion 420-421.

Saran

, Dykstra

D.M.

, Pisoni

R.L.

Timing of first cannulation and vascular access failure in haemodialysis: an analysis of practice patterns at dialysis facilities in the DOPPS. Nephrol Dial Transplant. 2004; 19 (9): 2334–2340.

10.

Schwab

S.J.

, Beathard

The hemodialysis catheter conundrum: hate living with them, but can't live without them. Kidney Int. 1999; 56 (1): 1–17.

11.

Roberts

T.L.

, Obrador

G.T.

, St Peter

W.L.

, Pereira

B.J.

, Collins

A.J.

Relationship among catheter insertions, vascular access infections, and anemia management in hemodialysis patients. Kidney Int. 2004; 66 (6): 2429–2436.

12.

Pastan

, Soucie

J.M.

, McClellan

W.M.

Vascular access and increased risk of death among hemodialysis patients. Kidney Int. 2002; 62 (2): 620–626.

13.

Collins

A.J.

, Foley

R.N.

, Gilbertson

D.T.

, Chen

S.C.

The state of chronic kidney disease, ESRD, and morbidity and mortality in the first year of dialysis. Clin J Am Soc Nephrol. 2009; 4 (Suppl 1): S5–S11.

14.

Wasse

, Speckman

R.A.

, Frankenfield

D.L.

, Rocco

M.V.

, McClellan

W.M.

Predictors of delayed transition from central venous catheter use to permanent vascular access among ESRD patients. Am J Kidney Dis. 2007; 49 (2): 276–283.

15.

Akoh

J.A.

Prosthetic arteriovenous grafts for hemodialysis. J Vasc Access. 2009; 10 (3): 137–147.

16.

Dixon

B.S.

, Beck

G.J.

, Vazquez

M.A.

; DAC Study Group. Effect of dipyridamole plus aspirin on hemodialysis graft patency. N Engl J Med. 2009; 360 (21): 2191–2201.

17.

Rooijens

P.P.

, Burgmans

J.P.

, Yo

T.I.

Autogenous radial-cephalic or prosthetic brachial-antecubital forearm loop AVF in patients with compromised vessels? A randomized, multicenter study of the patency of primary hemodialysis access. J Vasc Surg. 2005; 42 (3): 481–486, 487.

18.

Keuter

X.H.

, De Smet

A.A.

, Kessels

A.G.

, van der Sande

F.M.

, Welten

R.J.

, Tordoir

J.H.

A randomized multicenter study of the outcome of brachial-basilic arteriovenous fistula and prosthetic brachial-antecubital forearm loop as vascular access for hemodialysis. J Vasc Surg. 2008; 47 (2): 395–401.

19.

Kakkos

S.K.

, Topalidis

, Haddad

G.K.

, Shepard

A.D.

Long-term complication and patency rates of Vectra and IMPRA Carboflo vascular access grafts with aggressive monitoring, surveillance and endovascular management. Vascular. 2011; 19 (1): 21–28.

20.

Kakkos

S.K.

, Andrzejewski

, Haddad

J.A.

Equivalent secondary patency rates of upper extremity Vectra Vascular Access Grafts and transposed brachial-basilic fistulas with aggressive access surveillance and endovascular treatment. J Vasc Surg. 2008; 47 (2): 407–414.

21.

Chemla

E.S.

, Nelson

, Morsy

Early cannulation grafts in straight axillo-axillary angioaccesses avoid central catheter insertions. Semin Dial. 2011; 24 (4): 456–459.

22.

Schild

A.F.

, Schuman

E.S.

, Noicely

Early cannulation prosthetic graft (Flixene™) for arteriovenous access. J Vasc Access. 2011; 12 (3): 248–252.

23.

Lioupis

, Mistry

, Rix

, Chandak

, Tyrrell

, Valenti

Comparison among transposed brachiobasilic, brachio-brachial arteriovenous fistulas and Flixene™ vascular graft. J Vasc Access. 2011; 12 (1): 36–44.

24.

Allon

, Lok

C.E.

Dialysis fistula or graft: the role for randomized clinical trials. Clin J Am Soc Nephrol. 2010; 5 (12): 2348–2354.

25.

Taylor

, Gravel

, Johnston

, Embil

, Holton

, Paton

Canadian Hospital Epidemiology Committee. Canadian Nosocomial Infection Surveillance Program. Prospective surveillance for primary bloodstream infections occurring in Canadian hemodialysis units. Infect Control Hosp Epidemiol. 2002; 23 (12): 716–720.

26.

Grudzinski

, Quinan

, Kwok

, Pierratos

Sodium citrate 4% locking solution for central venous dialysis catheters—an effective, more cost-efficient alternative to heparin. Nephrol Dial Transplant. 2007; 22 (2): 471–476.