TITLE: Short- to midterm results of early cannulation arteriovenous grafts (Gore® ACUSEAL) for hemodialysis: Experience with the ACUSEAL in a Japanese cohort

BACKGROUND: In patients without suitable vasculature for autologous arteriovenous fistula, vascular access using a prosthetic graft is an option for hemodialysis. Gore® ACUSEAL Vascular graft is an early cannulation arteriovenous graft (AVG) that allows early puncture within 24 h after surgery. We aimed to report the outcomes of using this graft in patients from a single center.

METHODS: This study included 113 patients who underwent surgery for a new AVG using ACUSEAL, between December 2015 and December 2017, and were followed up. The primary outcomes were primary patency, assisted-primary patency, and secondary patency. Secondary outcomes were postoperative complications such as graft infection and steal syndrome.

RESULTS: Of the 113 patients, 60 were male and 53 were female. The average age was 74.4 ± 10.7 years. We could cannulate 69.1% of patients within 24 h. The average follow-up period was 20.1 ± 10.8 months. The primary patency rates after 3 months, 6 months, and 1 year were 76.2%, 60.4%, and 33.8%, respectively. The assisted-primary patency rates after 3 months, 6 months, and 1 year were 88.8%, 73.2%, and 58.9%, respectively. The secondary patency rates after 3 months, 6 months, and 1 year were 100%, 100%, and 98.8%, respectively. Fourteen patients (12.4%) developed graft infection and two patients (1.8%) developed steal syndrome.

CONCLUSION: In our study, ACUSEAL showed satisfactory patency and acceptable complication rates in the short to medium term, similar to previous studies. ACUSEAL is beneficial for surgeons who are familiar with using AVG and for medical staff who control bleeding after dialysis. However, due to the large outer diameter of the graft, surgical wounds might become dehiscent, and careful designing of the subcutaneous graft route is necessary. It might be possible to reduce the rate of graft infection by planning the site and skin incision.

SOURCE: Honma K, Eguchi D. Short- to midterm results of early cannulation arteriovenous grafts (Gore® ACUSEAL) for hemodialysis: Experience with the ACUSEAL in a Japanese cohort[J]. J Vasc Access, 2020 :1129729820974250. DOI: 10.1177/1129729820974250. 

背景：在没有适合自体动静脉内瘘的血管系统的患者中，使用人工移植物进行血管通路是血液透析的一种选择。 Gore-ACUSEAL血管移植物是一种早期可穿刺的动静脉移植物（AVG），可在术后24小时内进行早期穿刺。我们旨在报告单个中心的患者中使用这类移植物的结果。

方法：这项研究纳入2015年12月至2017年12月期间使用ACUSEAL进行新的AVG手术的113例患者，并进行了随访。主要结局为一期通畅，辅助一期通畅和二期通畅。次要结果是术后并发症，例如移植物感染和盗窃综合症。

结果：113例患者中，男性60例，女性53例。平均年龄为74.4 ± 10.7岁。在69.1％的患者中，我们可以在24小时内给予穿刺。平均随访时间为20.1 ± 10.8个月。 3个月，6个月和1年后的一期通畅率分别为76.2％，60.4％和33.8％。 3个月，6个月和1年后的辅助一期通畅率分别为88.8％，73.2％和58.9％。 3个月，6个月和1年后的二期通畅率分别为100％，100％和98.8％。 14名患者（12.4％）发生了移植物感染，而2名患者（1.8％）发生了窃血综合征。

结论：在我们的研究中，ACUSEAL在中短期内显示出令人满意的通畅性和可接受的并发症发生率，与以前的研究相似。 ACUSEAL对于熟悉AVG的外科医生以及在透析后控制出血的医护人员而言非常有用。但是，由于移植物的外径较大，手术伤口可能会裂开，因此必须仔细设计皮下移植物的途径。通过计划部位和皮肤切口，有可能降低移植物感染率。

启发：对于没有适合血管行自体AVF的患者，即穿型人工血管是一个不错的选择。