Delamination of Acuseal early cannulation arteriovenous graft months after implantation

Suemitsu, Kotaro; Shiraki, Tatsuya; Miyamoto, Masahito; Sasagawa, N; Nakamura, Toshio; Izumi, Masayuki

doi:10.1177/1129729820933396

Cited by 4 publications

(11 citation statements)

References 10 publications

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“…A previous study demonstrated that two cases of the delamination occurred at the elbow joint, suggesting that the delamination might be due to the repeated movement of the elbow. 5 However, none of the delamination and dissections in the present study occurred at any joints. In the present study, the patients did not receive anti-platelet, anti-coagulation, or thrombolytic therapies except that only one patient was on aspirin treatment.…”

Section: Discussionmentioning

confidence: 59%

“…We report four cases with dissections and delamination of the Acuseal AV graft. With the previous reported cases, [3][4][5] there are 12 cases of Acuseal graft dissection and delamination. In addition, there is a case report that described a dissection of a Hybrid AV graft.…”

Section: Discussionmentioning

confidence: 82%

“…Stenting and observation without intervention have been used in previous studies. 4,5 The four cases in the present report were managed with observation, stenting, false lumen volume reduction, and graft replacement, respectively. From the limited data and experience, covered stents and graft replacement or partial replacement are preferred treatment for graft delamination and dissection.…”

Section: Discussionmentioning

confidence: 84%

“…In a previous study, three cases with graft delamination had been under observation without intervention for 3–5 months, but self-restoration was not observed. 5 Therefore, whether the graft dissection and delamination need intervention warrants further investigation.…”

Section: Discussionmentioning

confidence: 99%

“…A few cases of graft delamination have been reported last year. [3][4][5] However, the clinical characteristics and pathogenic mechanisms of AV graft delamination and dissection are largely unknown probably due to inadequate clinical observation and limited case reports. Moreover, the treatment of graft delamination or dissection has not been standardized.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

J Vasc Access

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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.

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

J Vasc Access

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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 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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Delamination of Acuseal early cannulation arteriovenous graft months after implantation

Cited by 4 publications

References 10 publications

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

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

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

Delamination of Acuseal arteriovenous graft: Two case reports

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