Delamination and dissection of arteriovenous grafts: A multicenter report of four cases

Abstract

Arteriovenous (AV) grafts are an alternative vascular access for chronic hemodialysis. AV graft failure is often due to stenosis of the feeding artery, graft, or draining vein. We report four cases of AV graft dysfunction and failure rarely caused by graft delamination and dissection. Two males and two females aged 47–67 years had been on chronic hemodialysis. Ultrasound examination detected graft delamination and dissection between 1 and 33 months after Acuseal AV graft implantation. Two cases were successfully treated with stenting and partial graft replacement, respectively. False lumen volume reduction by fluid withdrawal failed to salvage the delaminated graft in one of the patients. The delamination and dissection of another case spontaneously resolved 5 months later. Graft delamination and dissection should be considered as a possible cause for AV graft dysfunction and failure. Stenting and graft replacement may be recommended to treat AV graft dissection and delamination.

Delamination of Acuseal arteriovenous graft: Two case reports

“…In almost all reports, the separations occurred between the elastomeric middle layers and the outer ePTFE layers, suggesting weak adhesion between each layer (Table 1). 5–8 Case 1 indicated a similar finding. Our literature search revealed that only one report demonstrated delamination between the luminal ePTFE layer and the elastomeric middle layer (Table 1).…”

“…In recent years, several reports have been published on Acuseal delamination (Table 1). [4][5][6][7][8] We identified Acuseal delamination in 5.6% (2/36) of cases, and previous reports showed a case rate of 5.1%. 6 While several studies had reported on complications of Acuseal use, no studies have focused on delamination.…”

“…In numerous previous case reports, aggressive therapies were performed such as stenting and graft replacement (Table 1). 4–8 We experienced the self-healing of Acuseal delamination in case 1 just after the PTA without improvement in appearance. In case 2, if the graft infection had not occurred, the patient could have continued to use the AVG despite having an Acuseal delamination segment.…”

“…Previous studies showed comparable patency and complication rates between Acuseal grafts and other standard grafts. [1][2][3] Though, several cases of Acuseal delamination have been reported in recent years, [4][5][6][7][8] the characteristics and etiologies remain unclear at present. Herein, we report two rare cases of Acuseal delamination having different characteristics.…”