Long-Term Favorable Results by Arteriovenous Graft with Omniflow II Prosthesis for Hemodialysis

Abstract

Aims and Methods: In order to decrease arteriovenous graft (AVG) failure and improve long-term patency, we used Omniflow II to perform AVG for hemodialysis access in 38 patients with very compromised vessels who were not suitable for other forms of AVG. Results: At a median follow-up of 38 (range 6–55) months, 31/38 (81%) patients were still alive. At 6, 12 ,18 and 24 months, primary patency was 92, 80, 68 and 60%, whereas secondary patency was 83, 80, 78 and 75%, respectively. The cumulative 38-month prosthetic AVG patency was 70%. No infective event related to the vascular prosthesis occurred. Neither AVG thrombosis nor modifications in thrombophilic pattern were observed; these findings confirm the high hemocompatibility of this prosthetic vascular device. Conclusion: Our experience is extremely encouraging for the use of new biosynthetic devices such as Omniflow II.

Editor's Choice – Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS)

“…219 A removable plastic sheath prevents stretching during tunnelling, thereby reducing perigraft seroma caused by "sweating" and improving patency in one non-randomised study. 232 A biosynthetic graft consisting of a collagenpolyester composite gave acceptable results in one small observational study 233 but had significantly poorer primary patency than BBAVFs in another small randomised study. 204 Because there are no comprehensive randomised studies comparing several grafts, no definite recommendations can be made concerning which graft should be used routinely but a self-sealing graft would be advisable for patients who have difficult central venous access and who require early HD.…”

Clinical results of biologic prosthesis: A systematic review and meta-analysis of comparative studies

“…The bioprosthesis derived from bovine mesenteric veins, obtained by process of glutaraldehyde cross linking, has been reported longer patency, lower rates of reoperation, and lower incidence of thrombosis [17] . Biosynthetic prosthesis, a glutaraldehyde-tanned ovine collagen-polyester composite, obtained by inserting polyester mesh-covered mandrills beneath the cutaneous trunci muscle of sheep has the advantage of the natural collagen, deprived of its immunogenicity and the polyester net provides increased mechanical resistance to deterioration [18] . Polytetrafluoroethylene (PTFE) is the most popular graft material, despite its higher incidence of graft thrombosis, infection, and seroma formation.…”

Vascular replacement using a layered elastin-collagen vascular graft in a porcine model: one week patency versus one month occlusion

“…8 Applications of such natural vascular grafts are as peripheral bypass, in vascular access/repair, and for arteriovenous shunting in hemodialysis. 11 Next to fibrillar structures as components of grafts, glycosaminoglycans such as heparin/heparan sulfate have been applied. Glycosaminoglycan-based grafts, such as hyaluronan-based tubular constructs, have been used for grafting in rat aorta and porcine carotid arteries, 12,13 resulting in deposition of circumferentially organized elastic fibers.…”