Use of biosynthetic grafts (Omniflow II) for high infection risk haemodialysis vascular access.
OBJECTIVE
Infective complications of patients requiring insertion of arteriovenous grafts for hemodialysis remain a challenge. In particular, patients who have exhausted autologous options and have had recent infective complications relating to alternative dialysis modalities such as peritonitis or central venous catheter-associated bacteremia can pose a significant dilemma. We present a series of challenging cases that represent examples of the use of biosynthetic grafts in patients with on-going infective risks. A review of available literature for the use of the Omniflow II graft in dialysis access is included.


METHODS
Electronic databases were searched for studies assessing the use of the Omniflow II graft for dialysis in accordance with PRISMA published up to 31st March 2014. The primary outcomes for this study were 1-year primary and secondary patency rates. Secondary outcomes were rates of infection and aneurysmal degeneration.


RESULTS
Three cases are described that were considered at high risk of infection and all successfully managed with the Omniflow II arteriovenous graft (AVG). None showed signs of infection and all grafts were patent at three months' follow-up. On review of the literature and following strict criteria, four studies were included with a total of 236 procedures. We found that the one-year primary patency rate for Omniflow II AVGs was 60.1% (53.6-66.5) with a secondary patency rate of 82.1% (76.7-86.9). Infection rates are reported at 0% to 5.7%, with aneurysmal rates ranging between 0% and 6.8%.


CONCLUSIONS
This small series reports on the successful use of the Omniflow II graft in patients with high risk of infection and, whilst limited in its size and scientific design, it does support the limited existing literature for the potential benefits of the biosynthetic approach where concerns regarding infective complications of synthetic material exist.
Department of Renal Surgery, QEHB, University Hospital Birmingham, Birmingham - UK.|ReDVA Research Consortium, Dundee - UK.
Julien
J
Al Shakarchi
Department of Renal Surgery, QEHB, University Hospital Birmingham, Birmingham - UK.
Damian
D
McGrogan
Department of Renal Surgery, QEHB, University Hospital Birmingham, Birmingham - UK.
Philip J
PJ
Yates
Department of Renal Surgery, QEHB, University Hospital Birmingham, Birmingham - UK.|ReDVA Research Consortium, Dundee - UK.
Nicholas
N
Inston
D000328:Adult; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000295:instrumentation*; D001705:Bioprosthesis / Q000009:adverse effects; D001807:Blood Vessel Prosthesis / Q000009:adverse effects; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000382:microbiology / Q000517:prevention & control*; D006435:Renal Dialysis; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency