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

Xi, Zhang; Hu, Bo; Xu, Yong; Lai, Qiquan; Chen, Ling; Gao, Xin; Tang, Bo; Chen, Bin; Zhou, Yu Jie; Wan, Ziming

doi:10.1177/11297298221074455

Cited by 2 publications

(4 citation statements)

References 6 publications

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“…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).…”

Section: Discussionsupporting

confidence: 54%

“…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.…”

Section: Discussionmentioning

confidence: 51%

“…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.…”

Section: Discussionmentioning

confidence: 95%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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Delamination of Acuseal arteriovenous graft: Two case reports

et al. 2023

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Acuseal arteriovenous graft is an early cannulation graft having a tri-layered structure with an elastomeric middle layer. However, delamination of Acuseal grafts has been reported recently. This article describes two cases with different characteristics of Acuseal delamination. In case 1, the delamination occurred 1 month after a percutaneous transluminal angioplasty (PTA); therefore, the PTA was suspected to be a trigger. The delamination was located between the outer expanded polytetrafluoroethylene (ePTFE) layer and the elastomeric middle layer. On the other hand, in case 2, the delamination was located between the luminal ePTFE layer and the elastomeric middle layer. A surveillance ultrasound examination detected the delamination unexpectedly in the uneventful course; however, the delaminating location corresponded to the cannulation puncture site and the intraoperative findings suggested the involvement of mis-needling as a possible cause. Interestingly, for the purpose of continued use on hemodialysis, specific treatments were required against the delamination itself in both cases. As we identified Acuseal delamination in 5.6% (2/36) of cases, concerns arise that numerous cases of Acuseal delamination may have been overlooked in general. Understanding and recognizing this phenomenon are important for adequate use of Acuseal graft.

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 51%

Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

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Delamination of Acuseal arteriovenous graft: Two case reports

et al. 2023

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AVG delamination: a cause of early cannulation arteriovenous graft dysfunction in hemodialysis patients

Wang,

Liu,

Liang

et al. 2024

Annals of Medicine

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Background A series of cases have reported graft delamination as a rare complication of early-cannulation arteriovenous graft (ecAVG). The unique multilayer structure of ecAVGs contributes to the property of cannulation as early as hours after implantation, but on other hand it takes the risk of graft delamination. However, the underlying mechanism and management of graft delamination as well as its effects on the long-term patency of ecAVGs have not been systemically analyzed. Methodsz A retrospective study was conducted in a cohort of patients who required an ecAVG for hemodialysis (HD) access in our center between April 2017 and December 2021. The characteristics of graft delamination and the outcomes of its different treatments were analyzed. Results A total of 144 ecAVGs were established in 141 end-stage renal disease (ESRD) patients, including 124 (86.1%) Acuseal grafts and 20 (13.9%) Flixene grafts. During follow-up 24.5(11.5, 45.8) months, 11 (7.6%) subjects had graft infection with an incidence of 0.03 patient-year. Thirteen (9.0%) subjects had graft delamination at 9.3(5.0,12.4) months after ecAVG implantation, with an incidence of 0.04 per patient-year. ecAVG delamination was observed in both Acuseal grafts (0.037 per patient-year) and Flixene grafts (0.055 per patient-year). Thrombosis or venous hypertension was the most common complaints. Seven delamination was observed at 1.3 (0.1, 4.2) months after an endovascular procedure. The primary patency, primary assistant patency and secondary patency in delamination group were significantly lower than that in non-delamination group ( p < 0.05). Post-procedure primary patency of group A (percutaneous transluminal angioplasty, PTA), group B (stenting) and group C (partial graft replacement, PGR) were 1.3 (0.45,4.22) months, 5.3 (3.05,6.85) months and 8.45 (4.78,14.53) months respectively ( p = 0.029). Conclusions Graft delamination was not a rare complication of ecAVGs in this cohort. It significantly reduced the long-term patency of AVGs. PGR might be a more effective therapeutic way than endovascular treatments.

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

Cited by 2 publications

References 6 publications

Delamination of Acuseal arteriovenous graft: Two case reports

Delamination of Acuseal arteriovenous graft: Two case reports

AVG delamination: a cause of early cannulation arteriovenous graft dysfunction in hemodialysis patients

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