title: The use of the early cannulation prosthetic graft (Acuseal™) for angioaccess for haemodialysis.
abstract: OBJECTIVE
  Autogenous arteriovenous (AV) accesses are the preferred choice for the delivery of haemodialysis (HD). With an increase in the prevalence of end-stage renal disease and in the life expectancy of these patients, the quality and availability of superficial vessels can be limited and reduced with time. The use of prosthetic AV accesses may therefore become necessary for the delivery of HD. A new early cannulation vascular prosthesis (GORE® ACUSEAL Vascular Graft) has been introduced, developed to hinder suture line and cannulation needle bleeding. The authors report their experience with this new conduit at a London teaching hospital.
  
  
  METHODS
  Between May 2011 and June 2013, 52 patients underwent 55 procedures where the ACUSEAL® prosthetic AV access was utilized to facilitate HD. The majority of procedures involved the placement of prosthetic brachio-axillary accesses or prosthetic axillo-axillary chest accesses.
  
  
  RESULTS
  The 1-year primary and secondary patency was found to be 46% and 61%, respectively. Successful cannulation of the newly placed AV access was performed with 24 hours of surgery in 40 patients (73%). Tunnelled vascular catheters were required in only 10 (18%) patients. Six (11%) of the patients in the study suffered early complications, and 9 (16%) patients developed AV access infection.
  
  
  CONCLUSIONS
  These results show that, while providing patency results that compare favourably to those published for other types of regular prosthetic accesses, the conduits are amenable to very early cannulation with few cannulation-related complications. This leads to a dramatic reduction in the need for temporary or tunnelled catheters.
authors.affiliation: Vascular Institute, St George's Healthcare NHS Trust, London - UK.
authors.forename: Gary G D
authors.initials: GG
authors.lastname: Maytham
authors.affiliation: Vascular Institute, St George's Healthcare NHS Trust, London - UK.
authors.forename: H K
authors.initials: HK
authors.lastname: Sran
authors.affiliation: Vascular Institute, St George's Healthcare NHS Trust, London - UK.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Chemla
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D002404:Catheterization; D016208:Databases, Factual; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology; D006784:Hospitals, Teaching; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008131:London; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency