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Early Results of using Spiral Flow AV Graft: Is it a breakthrough solution to a difficult problem?
Hosam F. El Sayed, MD, Mark Davies, MD.
The Methodist Hospital, Houston, TX, USA.
Objective:
Although, the preferred method to create an access is native AV fistula, there is still a significant number of patients where this is not feasible. AV access grafts are frequently used in those patients and their patency rates are far from being ideal requiring frequent interventions to maintain their use. Their failure is usually related to stenosis of the venous outflow due to intimal hyperplasia, specifically near the venous anastomosis of the graft. Neo-intimal hyperplasia may, in part, be a normal cellular response to an abnormal (turbulent) flow environment created by the AV access. The Spiral flow graft creates a more natural spiral laminar flow at the venous end that is a hypothetically a more friendly hemodynamic environment thus reducing intimal hyperplasia and graft failure. We here report the early results of the largest available series of using the graft in AV access.
Methods:
Retrospective review of all cases using the Spiral Flow graft for AV access in our institution, Jan 2012 to August 2013. Patients were selected had no suitable superficial veins for native AV fistula. Demographics and comorbidities were recorded. Kaplan Meier curve analysis used to calculate 1ry, assisted 1ry and 2ry patency rates in comparison to historic control of straight ePTFE and heparin bonded grafts for the same indication in our institution. Complications were also recorded.
Results:
A total of 37 cases were included. The access site was the arm (19), the forearm (10), femoral (5) and chest wall (3). 2/3 were females, mean age of 60 years and mean follow up of 7 months. At 6 month, the primary, assisted primary and secondary patency rates were 90%, 90% and 100%, respectively. Only 3 grafts required thrombectomy during the follow up and continue to be used. Complications included 4 graft infections; 3 severe steal syndrome, 4 seromas and 2 arm swelling. There was only 1 early graft failure.
Conclusions:
Spiral flow grafts are a valid and successful option for AV access. Early results tend to be significantly superior to using straight ePTFE and heparin bonded grafts. This may be explained on the basis of the hemodynamics created by the spiral laminar flow and may be a significant contribution to preventing AV access graft failure.
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