PC102 Hybrid Vascular Graft for Vascular Access Creation: A Single-Center Experience

Arteriovenous grafts (AVG) present a feasible solution for creating a vascular access in patients who are unsuitable for autogenous fistulas (AVF). The quite poor outcomes associated with AVG are largely due to neointimal hyperplasia in the venous anastomosis. The aim of this study was to assess the patency rate of GORE Hybrid Vascular Grafts (HG) in vascular access for hemodialysis. This was a cohort study conducted from March 2013 to November 2016. All consecutive patients in whom an HG was implanted in our institution were included. Indications for HG were primary lack of native veins suitable for a direct fistula and secondary lack of native veins due to failure of a previous fistula. In patients suffering segmental occlusions or aneurysmatic lesions (prosthetic interpositions) a standard stretch graft was used. All patients requiring a secondary intervention were also referred to our center. Patients underwent ultrasound follow-up at 1, 3, and 6 months and then every 6 months. Outcomes were primary and cumulative (assisted and secondary) patency at 6, 12, and 24 months (Kaplan-Meier analysis). Patency was evaluated as no evidence of venous stenosis at duplex examination in functional accesses. Graft closures caused by pseudoaneurysm, death, infections, transplants, or related to proximal anastomosis were excluded from the data analysis. There were 29 grafts placed in 29 patients. In 22 patients, a 5-cm-long nitinol reinforced section (NRS) graft was used, in the other seven, the 10-cm NRS was selected. No patients suffered pseudoaneurysms and surgical closure; graft infections requiring excision were not recorded. Median follow-up was 17 months (2-43). Primary patency was 58.8%, 58.8%, and 50.4% at 6, 12, and 24 months respectively. Cumulative patency was 85.6% at 6 months and 71.4% at 12 and 24 months. Seven clotted grafts were recorded, in one case a central venous catheter was deployed, in the other six cases the clot was managed surgically and then an endovascular completion was done with stent graft deployment to treat the venous residual stenosis and to extend the NRS. Use of GORE Hybrid Vascular Graft seems to be effective in prevention of vein stenosis in AVG. Interestingly the majority of clotting events occurred in the first 6 months after access creation. Our data suggest to intensify follow-up protocol in this period to improve stenosis detection and treatment and to reduce the occurrence of thrombosed grafts. More data are needed to confirm our findings.