Early Cannulation Prosthetic Graft (Acuseal<sup>™</sup>) for Arteriovenous Access: A useful option to provide a Personal Vascular access Solution

Aitken, Emma; Jackson, Andrew; Kingsmore, David

doi:10.5301/jva.5000238

Cited by 50 publications

(49 citation statements)

References 19 publications

(17 reference statements)

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“…In most cases they continue to be used in situations analogous to conventional AVGs, where there are no alternative autologous options. Our group has recently published information on our successful use of ecAVGs as a "bridge" to autologous AVF maturation or transplantation in selected patients (23). However, this is the first study to propose the use of ecAVG as an alternative to TCVCs for the entire dialysis population.…”

Section: Discussionmentioning

confidence: 99%

Are Early Cannulation Arteriovenous Grafts (ecAVG) a Viable Alternative to Tunnelled Central venous Catheters (TCVCs)? An Observational “Virtual Study” and Budget Impact Analysis

et al. 2016

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Original articleprior to the anticipated date of dialysis commencement. If haemodialysis is required before this time, or if complications arise with the initial AVF creation (25%-35% of AVF fail at an early stage), then an alternative method of dialysis, generally via TCVC, is required (2).Dialysis via a TCVC confers significantly higher risk of infection, mortality and central venous stenosis than dialysis via an AVF. A recent national Scottish study of 2666 patients revealed a 2-to 3-fold increased risk in mortality (all-cause mortality, cardiovascular or infection related mortality) and a 7-fold increase in death from septicaemia with the use of TCVCs (3). The complications of vascular access are responsible for over 20% of all hospitalisations of patients on haemodialysis and account for one-third of all in-patient renal bed usage (4). It therefore follows that a strategy of TCVC minimisation or avoidance is likely to have significant benefits both to the individual and to the health service generally.Arteriovenous grafts (AVGs) may provide an alternative means of achieving vascular access in patients requiring

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Section: Discussionmentioning

confidence: 99%

Are Early Cannulation Arteriovenous Grafts (ecAVG) a Viable Alternative to Tunnelled Central venous Catheters (TCVCs)? An Observational “Virtual Study” and Budget Impact Analysis

et al. 2016

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“…Early results with this AVG in small, single-center, early-cannulation series were encouraging with respect to patency and complication rates. 8, 9 Tozzi's experience in Europe demonstrated good patency rates and low complication rates with early cannulation of this graft. 9 The FDA clearance of the AVG was based on some of the data from the FDA-authorized clinical study reported here.…”

mentioning

confidence: 95%

Prospective multicenter study with a 1-year analysis of a new vascular graft used for early cannulation in patients undergoing hemodialysis

Glickman¹,

Burgess

Cull

et al. 2015

Journal of Vascular Surgery

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This study demonstrated that the new, early-cannulation AVG graft can be cannulated soon after implantation without a significant difference in patency and complication rates compared with rates associated with standard cannulation of expanded polytetrafluoroethylene grafts in the literature. This new AVG may allow early removal or avoidance of TDC use in patients undergoing hemodialysis, potentially reducing or eliminating the number of days of catheter-dependent dialysis, but further studies will be needed to demonstrate this potential.

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“…23 This coupled with poorer outcomes from BBF in the patients over 60 years old 24 may favour a watchful waiting approach to these patients access creation. Perhaps early cannulation grafts 25,26 have a role in this subgroup of patients to permit avoidance of TCVCs but also minimize the morbidity associated with unnecessary access procedures. Such strategies would, however, need to be further evaluated given the high re-intervention rate required to maintain long-term patency of arteriovenous grafts.…”

Section: Utilization Of Avfmentioning

confidence: 99%

Brachiobasilic fistulae: an upper limb autologous option for everyone?

et al. 2016

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Purpose Autologous arteriovenous fistulae (AVF) are the vascular access option of choice. However, Brachiobasilic fistula (BBF) are complex procedures with variable outcomes reported in the literature. Our aim was to evaluate outcomes and morbidity associated with BBF in our population. Methods Retrospective analysis of prospectively collected data was undertaken for all 51 BBF created in our institution between January 2010 and March 2013. These were compared to an age and sex-matched group of brachiocephalic fistula (BCF) created over a similar time period. Demographic, operative and outcome data was collected for all patients. The primary end points were primary functional patency, primary-assisted patency and secondary patency at 3, 6 and 12 months. Continuous data was compared using Student's t-test and categorical data using chisquared test (p50.05 is significant). Results Mean patient age was 57 years (range: 21-82). About 45% were male. About 73% of patients were already on hemodialysis (HD) at the time of BBF creation. BBF was the secondary or tertiary access procedure in 60.8% of patients (n ¼ 31). BBF were associated with significant operative burden with 82% of patients requiring a general anaesthetic and median hospital admission of 2 days (range: 1-4). About 75% had a single-stage procedure. About 23.5% (n ¼ 12) required operative revision (superficialization or anastomotic revision for stenosis). Patients with BBF spent an additional 3.45 days/year in hospital as a result of access related complications compared to 0.56 days/year in the BCF group. Primary-assisted patency at 3, 6 and 12 months was better in the BCF group than BBF group (86%, 72% and 48% vs. 71%, 59%, 33%, respectively; p50.01) Primary functional and secondary patency rates at 3, 6 and 12 months were 74%, 58% and 32% and 78%, 63% and 41%, respectively, with an average of 0.33 procedures per AVF to maintain patency (10 fistuloplasties, 4 IR thrombectomy and 3 surgical thrombectomy). About 32% (n ¼ 17) of BBF were never used for HD (seven patients had a patent AVF but did not require HD418 months following creation; nine failed to adequately mature and one patient refused second stage superficialization). Conclusions BBF are associated with a significant initial operative burden and higher complication and poorer patency rates than BCF. About one-third of BBF created in this series were never used. Given the morbidity associated with this procedure, careful consideration should be given to creation of BBF in pre-dialysis patients particularly those in whom the rate of decline in renal function is slow. ARTICLE HISTORY

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Early Cannulation Prosthetic Graft (Acuseal^™) for Arteriovenous Access: A useful option to provide a Personal Vascular access Solution

Cited by 50 publications

References 19 publications

Are Early Cannulation Arteriovenous Grafts (ecAVG) a Viable Alternative to Tunnelled Central venous Catheters (TCVCs)? An Observational “Virtual Study” and Budget Impact Analysis

Are Early Cannulation Arteriovenous Grafts (ecAVG) a Viable Alternative to Tunnelled Central venous Catheters (TCVCs)? An Observational “Virtual Study” and Budget Impact Analysis

Prospective multicenter study with a 1-year analysis of a new vascular graft used for early cannulation in patients undergoing hemodialysis

Brachiobasilic fistulae: an upper limb autologous option for everyone?

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Early Cannulation Prosthetic Graft (Acuseal™) for Arteriovenous Access: A useful option to provide a Personal Vascular access Solution

Cited by 50 publications

References 19 publications

Are Early Cannulation Arteriovenous Grafts (ecAVG) a Viable Alternative to Tunnelled Central venous Catheters (TCVCs)? An Observational “Virtual Study” and Budget Impact Analysis

Are Early Cannulation Arteriovenous Grafts (ecAVG) a Viable Alternative to Tunnelled Central venous Catheters (TCVCs)? An Observational “Virtual Study” and Budget Impact Analysis

Prospective multicenter study with a 1-year analysis of a new vascular graft used for early cannulation in patients undergoing hemodialysis

Brachiobasilic fistulae: an upper limb autologous option for everyone?

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Product

Resources

About

Early Cannulation Prosthetic Graft (Acuseal^™) for Arteriovenous Access: A useful option to provide a Personal Vascular access Solution