UNASSIGNED: Autogenous arteriovenous fistula (AVF) is the preferred vascular access mode. However, the earliest possible time for AVF puncture and whether premature puncture affects the AVF patency rate remain unclear.
UNASSIGNED: In this multicenter retrospective cohort study, adult uremic patients who underwent AVF surgery for the first time at Taizhou Hospital or Enze Hospital of Zhejiang Province between September 1, 2018 and August 31, 2021 were enrolled. All patients were followed up for 1 year after puncture, and the status of fistula establishment and puncture, subsequent patency, loss to follow-up, renal transplantation, conversion to peritoneal dialysis, abandonment of the fistula, and death, were recorded.
UNASSIGNED: A total of 465 patients with AVFs were included in this study, including 59 (12.7%) patients with fistulas that were cannulated within 30 days. In the early puncture group, the levels of serum creatinine and urea nitrogen were higher, while the levels of hemoglobin and albumin were lower, suggesting that these patients needed urgent dialysis. Furthermore, the rate of non-cuffed catheter use was higher, while the rate of cuffed catheter use was lower, and femoral vein puncture was preferred over internal jugular vein puncture. The mean duration of catheter indwelling was shorter in the early puncture group (19 vs 70 days, p < 0.001). The estimated AVF primary and cumulative functional patency at 12 months was 81.1% versus 82.3% and 98.3% versus 98.7% in the early puncture and control groups, respectively. Kaplan-Meier analysis revealed no significant difference in AVF primary and cumulative functional patency between the two groups.
UNASSIGNED: In patients with an established fistula in urgent need of hemodialysis, to avoid new catheterization, a puncture can be performed within 30 days in those with well-developed blood vessels after adequate ultrasound and clinical evaluation without affecting the patency of the fistula.

BACKGROUND: The use of Acuseal arteriovenous graft (AAVG) is spreading in end-stage renal disease (ESRD) patients for its advantages in early cannulation. However, comparison of clinical outcomes between AAVGs and standard arteriovenous grafts (SAVGs) is limited. In this study, we compared the performance of AAVGs and SAVGs.
METHODS: Consecutive ESRD patients underwent prosthetic vascular access between October 2017 and May 2019 at a single center were identified. Patients were divided into AAVG group and SAVG group. Patients\' demographics, perioperative characteristics, and clinical outcomes were collected. Primary, primary assisted, and secondary patency rates were compared using Kaplan-Meier analyses. Postsurgery complications were compared using chi-square test or the Fisher\'s exact test.
RESULTS: A total of 304 arteriovenous grafts (AVGs) were implanted in 145 males and 159 females (mean age, 60.1 years; range, 20-91 years), comprising 143 AAVGs and 161 SAVGs. Median time to first cannulation was 3 days (interquartile range [IQR], 1-15 days) in the AAVG group and 30 days (IQR, 20-52 days) in the SAVG group (P < 0.001). Adjusted primary, primary assisted, and secondary patency at 12 months were not significant different between AAVGs and SAVGs (P = 0.911, P = 0.945, and P = 0.640, respectively). There was no statistical significance in regards to thrombosis (AAVG, 34.3%; SAVG, 26.1%; P = 0.120) and infection (AAVG, 4.9%; SAVG, 2.5%; P = 0.261) between the groups.
CONCLUSIONS: Acuseal grafts provide comparable patency, and complication rates to SAVGs, with less time to first cannulation from the graft implanted.

UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.

UNASSIGNED: Most guidelines in different countries recommend waiting more than 2 weeks for the initial cannulation of an arteriovenous fistula (AVF) after its creation. Although an experienced examiner can subjectively determine if an AVF is ready for early cannulation, there is a lack of objective information to guide whether early cannulation is appropriate or how early cannulation may affect an AVF\'s primary patency. The current study examined the relationship between the initial cannulation and the prognosis of AVF, considering ultrasonography (US) findings.
UNASSIGNED: This retrospective observational study enrolled 103 patients with end-stage renal disease who had started hemodialysis therapy from 2013 to 2015 at the Juntendo University Hospital. All patients had been given a primary AVF before or after the initiation of dialysis, had undergone US examinations both before and 7 days after surgery, had initially cannulated the AVF at ≥7 days after surgery, and were observed for over 1 year.
UNASSIGNED: The factor associated with the loss of primary patency was a resistance index of brachial artery ≥0.65 on US examination at 7 days after surgery. There was no significant difference in patency rate between the early (within 14 days after surgery) and late initial cannulation groups (≥15 days after surgery).
UNASSIGNED: Because a resistance index <0.65 on US findings at 7 days after surgery was a good indicator for predicting an excellent patency rate when we performed first cannulation of AVF located in the forearm within 2 weeks after its creation, 1-week postoperative US evaluation may provide crucial information.

Arteriovenous fistula is recommended, but arteriovenous graft is acceptable when a fistula is not possible. Acuseal is an early cannulation graft with a trilayer structure. Although primary patency rates of Acuseal appear to be similar to those of other standard grafts, few studies have investigated long-term results and complications. In our series, delamination of the wall structure occurred in 5.1% (6/115) by 21 months after Acuseal implantation. The causes could be divided into cannulation-related and cannulation-unrelated. Here, we describe the six cases in which delamination of the wall structure occurred in the medium term after Acuseal implantation.

Currently, there is no vascular access that possesses all ideal qualities for hemodialysis access, but attributes particularly lacking include: ease of identification (cannulation zone), ease of access, resistance to stenosis, durable to repetitive cannulation, resistance to infection, resistance to acute needle-related injuries, and instant hemostasis. The overall value of these attributes could be appreciated in the reduction of complications (patient burden and suffering, which can also result in increased healthcare costs), and improved safety and durability. In this case report, we present a novel hemodialysis access graft that has the potential to provide the following benefits: it is designed to be self-sealing and immediately usable post implant, easy to identify, easy to access, has more durable cannulation zones, and protects from needle-related injuries. This case report describes the first-in-man use of this novel graft technology to replace a giant, thrombotic, and difficult-to-access arteriovenous fistula to provide the patient with a potentially safer and more durable access that does not require placement of a bridging dialysis catheter. This single-patient experience suggests that implantation and function of this novel graft as a hemodialysis access is feasible in a human subject with end-stage renal disease, and it suggests that the novel properties (i.e. immediate use, easy identification, easy use, cannulation zone durability, and protection from needle-related injuries) of this graft seem to function as intended.

Plastic cannulas have been used to cannulate arteriovenous fistulas (AVFs) for hemodialysis (HD) in Japan for many years. However, the effect of early cannulation with plastic cannulas on AVF patency is not known.
We analyzed the relationship between first cannulation time (FCT) and patency rates for AVFs cannulated with plastic cannulas and investigated whether early cannulation with plastic cannulas affects AVF patency.
In total, 122 patients who underwent primary AVF construction were divided into an early cannulation group (FCT <10 days) and a late cannulation group (FCT ≥10 days). The Kaplan-Meier method and multivariable Cox regression models were used to investigate AVF patency.
Median FCT was 6 days. There was no statistically significant between-group difference in primary (p = 0.643) or secondary (p = 0.453) patency rates. Early or late cannulation was not significantly associated with primary patency (hazard ratio [HR] 1.21; 95% CI 0.71-2.05) or secondary patency (HR 0.46; 95% CI 0.08-2.77) after adjustment for age, sex, presence of diabetes mellitus or hypertension, and HD at baseline.
Early AVF cannulation (<10 days from creation) with plastic cannulas does not affect access patency, and it may be possible to cannulate AVFs earlier than 10 days to decrease the need for use of a central venous catheter.

UNASSIGNED: The optimal vascular access for most dialysis patients is an arteriovenous fistula and the recognized appropriate process of care for the chronic kidney disease patient is to have the access in place ready for use when renal replacement therapy is required. Unfortunately, as a result of multiple barriers, most patients start dialysis with a catheter and many experience multiple interventions. The recent advent of the percutaneous arteriovenous fistula may offer at least a partial solution to these problems. The purpose of this study was to report of the results of early cannulation of the percutaneous arteriovenous fistula.
UNASSIGNED: Early cannulation, less than 14 days post creation, was performed in 14 cases in order to avoid an initial catheter or continued use of a problematic catheter for dialysis. Immediately post access creation, blood flow ranged from 491 to 1169 mL/min (mean = 790 mL/min). Ultrasound was used to map potential cannulation sites prior to use. Cannulation was performed using plastic fistula cannulas.
UNASSIGNED: Early cannulation was successful in this cohort of cases except for one cannulation complication. Dialysis treatments were otherwise uncomplicated. Primary patency at 3, 6, and 12 months was 76%, 76%, and 66%, respectively. Assisted primary patency for the same intervals was 100%, 100%, and 91%, respectively. Cumulative patency was 100% at all three-time intervals.
UNASSIGNED: The results of this study suggest that the possibility of successful early cannulation with a percutaneous arteriovenous fistula can be considered as an additional factor in making this access a reasonable alternative for a surgically created arteriovenous fistula in appropriate patients.

UNASSIGNED: No technology has been specifically developed with the intent to reduce needle-related vascular access injuries; a significant source of complications and abandonment. We present the initial pre-clinical study results of a novel, self-sealing, immediate cannulation dialysis graft that aims to prevent needle-related complications; to promote safe, reliable needle access; to reduce catheter use; and could facilitate home hemodialyisis.
UNASSIGNED: The innovative graft design consists of two cannulation chambers with self-sealing properties and materials that prevent side and back wall needle puncture. Study and control grafts (expanded polytetrafluoroethylene) were implanted in one pig and 10 sheep in two studies over the course of 1 year. First cannulation occurred immediately post implant for all study grafts. Post-cannulation time to hemostasis, hematoma and seroma formation, infection, and patency were recorded.
UNASSIGNED: The two studies account for nearly 60 weeks (average 6.4 weeks/graft) of study graft follow-up. In the ovine study, average study graft time to hemostasis was 27.3 s (standard deviation = 26.3, range = 0-120), and the control averaged 177.2 s (standard deviation = 113.4, range = 60-600), p < 0.0001. Secondary patency was 75% and 67% for the study and control grafts, respectively. Neither study nor control groups experienced seroma, graft infections, or deaths.
UNASSIGNED: All novel grafts in the studies were implanted successfully and functioned as intended. There were no complications related to tunneling of the study graft and the chamber prevented back/side wall needle injury. This novel technology may help to mitigate these needle-related complications, while allowing for early/immediate cannulation which could also reduce catheter contact time.

UNASSIGNED: In patients who receive chronic hemodialysis but do not have autogenous venous conduit for a native dialysis access, nonautologous grafts serve as an alternative conduit of choice. This study compared the clinical outcome of hemodialysis access using bovine carotid artery graft (BCAG) and prosthetic polytetrafluoroethylene (PTFE) graft in patients who receive chronic hemodialysis.
UNASSIGNED: An analysis of all patients undergoing hemodialysis using either BCAG or PTFE grafts from 2010 to 2017 was performed. Clinical outcomes were analyzed including graft patency as well as associated complications related to dialysis grafts and tunneled dialysis catheter (TDC).
UNASSIGNED: During the study period, 142 patients received BCAG and 128 patients received PTFE graft implantation for dialysis access. The mean duration from graft implantation to graft cannulation in the BCAG and PTFE group was 12.3 ± 8.5 days versus 43.5 ± 16.4, respectively ( P = .01). Bovine carotid artery graft group had a higher 2-year primary patency rate (33% vs 14%, P = .03) and assisted primary rate (57% vs 23%, P = .02) compared to the PTFE group. The 2-year secondary patency rates were similar between the 2 groups (56% vs 53%, P = .69). Complication rates in the BCAG and PTFE group was 1.69 ± 0.24 per patient-year versus 2.54 ± 0.48 per patient-year, respectively ( P = .01). Tunneled dialysis catheter-related infection was greater in the PTFE group compared to the BCAG group (10.87 ± 2.61 vs 5.69 ± 0.98 per 1000 TDC days; P = .02). Bovine carotid artery graft cohorts group required a mean of 1.69 interventions per patient-year, compared to 2.76 per patient-year for the PTFE group ( P = .03).
UNASSIGNED: Bovine carotid artery graft permits earlier cannulation for hemodialysis access with superior primary and assisted primary patency rates compared to PTFE grafts. Patients with BCAG experienced shorter indwelling TDC duration and less TDC-related complications compared to PTFE cohorts.