Clinical and Doppler ultrasonography data of a polyurethane vascular access graft for haemodialysis: a prospective study

• Published in: Nephrology, dialysis, transplantation Vol. 18; no. 7; pp. 1397 - 1400
• Main Authors: Wiese, Patrick, Blume, Jochen, Mueller, Hans‐Joachim, Renner, Hermann, Nonnast‐Daniel, and Barbara
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.07.2003
• Subjects: Adult; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood Vessel Prosthesis - adverse effects; Blood Vessel Prosthesis Implantation - adverse effects; Catheterization - adverse effects; Catheters, Indwelling - adverse effects; Doppler ultrasonography; early cannulation; Emergency and intensive care: renal failure. Dialysis management; Female; haemodialysis; Humans; Intensive care medicine; Kidney Failure, Chronic - therapy; Male; Medical sciences; Middle Aged; polyurethane graft; Polyurethanes - therapeutic use; Postoperative Complications; Prospective Studies; prospective study; Regional Blood Flow - physiology; Renal Dialysis - adverse effects; Time Factors; Ultrasonography, Doppler, Color; vascular access; Vascular Patency - physiology; Sonography; Doppler ultrasound study; Performance evaluation; Human; Doppler ultrasonography; Venous access; Hemodialysis; haemodialysis; Cannulation; polyurethane graft; Extrarenal dialysis; early cannulation; Polyurethane; prospective study; Technique; vascular access
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfg168

Background. Absence of a permanent vascular access in most patients starting haemodialysis remains a cause of high morbidity and costs. This study obtained new clinical and colour Doppler ultrasound (CDU) data of a polyurethane vascular access graft (PVAG) proposing early post‐operative cannulation. Methods. Baseline characteristics were determined in 15 patients and the PVAGs were evaluated prospectively including first cannulation, patency and complications. CDU was used post‐operatively and after 1 year for assessing graft morphology and access blood flow. Results. PVAGs were cannulated at a median of 4 days post‐operatively. The 1‐year primary patency of the PVAG was 66.7%. During the 15 months observation three grafts thrombosed, one was replaced because of infection and one because of ischaemia. CDU measurements at the feeding brachial artery revealed a mean initial access volume flow of 773±89 ml/min, being significantly higher in patients without thrombosis compared to patients with thrombotic events (930±90 vs 375±143 ml/min, P<0.05). The initial inability to directly monitor PVAGs by CDU changed at sites of frequent centesis, where Doppler signals and luminal morphology could be evaluated in the follow up examination. Conclusions. The PVAG offers early access for urgent haemodialysis. CDU for access volume flow measurement at the feeding brachial artery contributes to predict access thrombosis. Direct non‐invasive graft imaging is limited and the ultrasonographical changes in the polyurethane material enabling graft monitoring after repeated cannulation might indicate an injury of the graft with increased risk for access failure.