Early experience with a newly developed electrospun polycarbonate-urethane vascular graft for hemodialysis access

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Abstract

Purpose:

In this pilot study, we tested a newly developed electrospun multilayered, self-sealing graft, AVfloTM, specifically designed for early hemodialysis access.

Methods:

Ten eligible consenting patients had a polycarbonate-urethane graft (AVfloTM) implanted and were followed up prospectively for at least six months. Performance measures included graft patency, complications and time to first cannulation. Mean age of the patients was 66.7 ± 10 years. Chronic glomerulonephritis was the most common cause of renal failure. A total of 70% of the patients had a history of previous vascular access and 40% history of minimally invasive radiologic procedures for patency maintenance. In 40% of the cases the need for AV graft implantation was because of recurrent infections from permanent catheter for dialysis. Seven grafts were placed in the upper arm and three in the thigh. Mean follow up was 230 ± 75 days.

Results:

There were no systemic or local reactions to the graft and we did not report any graft infections. Two grafts thrombosed because of severe bleeding post-cannulation due to an incorrect needle puncture. Both grafts were successfully thrombectomized. Primary and secondary patency rates at six months were 60% and 78%, respectively. These patency rates were comparable to those reported for other polyether-urethane and ePTFE grafts. Median time to first cannulation was seven days (3–21) and all puncture sites sealed in less than five minutes.

Conclusions:

This newly developed electrospun polycarbonate-urethane graft is safe in humans, permits early access obviating the need for venous catheters, and has equivalent patency as other prosthetic grafts.

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