Intravenous spiral support for the prevention of outflow-tract stenosis in av-shunts for hemodialysis?
Intraluminal spiral support of bovine heterografts (Solcograft-P) offers promising mechanical characteristics for av-shunts. Using a tunneling technique the spiral prevents twisting and kinking during subcutaneous placement and allows prolonged and vigorous post-puncture compression for hemostasis without compromising shunt flow. Canine experiments (femoro-femoral loop) suggest that additional insertion of the spiral into the efferent vein for some centimeters can prevent or delay the development of outflow-tract stenosis, the main cause of late shunt failure (0% (0/5) vs. 75% (3/4) significant stenosis; total patency rate 90% (9/10); follow-up 3 months). Preliminary clinical results with brachio-cephalic/basilic av-shunts in the forearm (loop) support our experimental investigations. In all eight patients the shunt is functioning perfectly without reinterventions being necessary (mean follow-up 8.8 months, totally 55 dialysis months). In five patients the shunt was used early for hemodialysis (days 1-10 post operation). Angiographically, stenoses developed in the outflow-tract in five of six shunts, but only one stenosis was observed in the spiral-supported venous segment where it usually occurs. In some cases shunt function was preserved by collaterals from the nonstenotic spiral-supported venous segment despite occlusion of the main efferent vein. Thus, it appears that a spiral placed into the graft and efferent vein is suitable to prolong the functional life of av-shunts.
D000328:Adult; D000818:Animals; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000295:instrumentation*; D003251:Constriction, Pathologic / Q000517:prevention & control; D004285:Dogs; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D013997:Time Factors