The use of the early cannulation prosthetic graft (Acuseal^™) for angioaccess for haemodialysis

Abstract

These results show that, while providing patency results that compare favourably to those published for other types of regular prosthetic accesses, the conduits are amenable to very early cannulation with few cannulation-related complications. This leads to a dramatic reduction in the need for temporary or tunnelled catheters.

Current Experience and Midterm Follow-up of Immediate-Access Arteriovenous Grafts

“…Overall, our outcomes, particularly the 1-year secondary-patency rate of 58.3%, are congruent with those published in industry-sponsored trials as well as in the more stringent European setting. 7,8…”

“…7,14,15 In Maytham’s independent European series of 55 Acuseal grafts, 1-year results were notable for 12 month primary patency of 46% and secondary patency of 61%, with 73% of patients being cannulated within 24 hr of graft placement. 8 The largest prospective series (138 grafts) was published by Glickman in 2015 and reported a primary patency and secondary patency at 12 months of 33% and 78%, respectively. 8 When comparing our findings to the independent European series, there is congruity; however, when compared to Glickman’s industry-supported trial’s 1-year results, the primary patency results are comparable, yet there was a significant disparity in the cumulative patency and the total number of reinterventions.…”

“…8 The largest prospective series (138 grafts) was published by Glickman in 2015 and reported a primary patency and secondary patency at 12 months of 33% and 78%, respectively. 8 When comparing our findings to the independent European series, there is congruity; however, when compared to Glickman’s industry-supported trial’s 1-year results, the primary patency results are comparable, yet there was a significant disparity in the cumulative patency and the total number of reinterventions. The Glickman study describes a cumulative patency rate of 79%, but with a larger number of reinterventions (1.6 per-access) to achieve this outcome.…”

New Insights into Dialysis Vascular Access: What Is the Optimal Vascular Access Type and Timing of Access Creation in CKD and Dialysis Patients?

“…For patients who are predialysis, the urgency to initiate dialysis is a core consideration affecting AV access choice. For example, a CVC can be avoided by using a prosthetic early cannulation AV graft that can be used in as little as 24 hours after creation (1,2) in patients without an already established vascular access, who urgently need to initiate HD. In contrast, while AVFs should be considered in all appropriate patients, AVFs require a minimum of 4 weeks and up to 9 months before they are suitable for HD in North America.…”

Hemodialysis vascular access in the elderly—getting it right

“…Instead, placement of an AVG that can be used within hours to days (for early cannulation grafts) to a couple of weeks (depending on the material used) has been r e v i e w AK Viecelli and CE Lok: Hemodialysis vascular access in the elderly shown to be cost saving and associated with similar survival, fewer interventions to enable HD, and shorter CVC dependence compared with an AVF. [37][38][39][40][41][42][43] In a recent randomized controlled trial comparing the use of early cannulation grafts as an alternative to tunnelled CVC (AEAVF), investigators found that use of early cannulation grafts was associated with reduced rates of culture-proven bacteremia and mortality (risk ratio for bacteremia at 6 months, 0.2; 95% confidence interval 0.12-0.56; P ¼ 0.02 and mortality risk ratio, 0.3; 95% confidence interval 0.08-0.45; P ¼ 0.04). 44 Although this study was performed in a population with an urgent need to begin dialysis, the use of early cannulation AVGs is a viable CVC-limiting strategy and may be particularly useful in patients with limited life expectancy and/or who are at high risk of fistula maturation failure (e.g., poor vessels).…”