Introduction

Patients with few transplant options and failing dialysis access are challenging to manage. Transitioning away from a CVC to fistula / graft is often difficult. We describe the use of upper limb ecAVGs for dialysis access in an attempt to avoid CVCs.

Methods:

Analysis of prospectively collected dataof patients with upper limb ecAVG (Gore Acuseal) between April 2014 to April 2017 from a single centre.

Results:

41 patients (21 males) with a mean follow up of 458 days (85-814days). Mean age 61.5 years (24-79).

Primary cause of ESRF: Diabetes 29% (12), hypertension 15% (6), glomerulonephritis 15% (6) and idiopathic 15% (6) and miscellaneous causes 26% (11).

Past access History: 95% (39) patients had previous dialysis access (CVCs, AVF or AVG); 56% (22) had 3 or more prior accesses. 9.7% (4) patients were active on transplant waiting list.

Types of ecAVG:

Complications: Haematoma(1), steal (1) and infection (1)

Dialysis adequacy: Median time to needle the graft was 2 days (0-67).

Mean urea reduction rate was 72.5% at 6 months.

Patency: Functional patency rates were 73% (31 grafts) and 52% (22 grafts) at 6 and 12 months.

Radiological interventions: On average, there was 1.1 radiological intervention per patient during the study follow up.

Discussion:

Upper limb ecAVG can provide an alternative to CVCs in complex dialysis patients with few options. Excellent adequacy with few complications are possible. Durability is comparable to other graft series.

CITATION INFORMATION: Khurram M., Mosca I., Calder F. Upper Limb Early Cannulation Arteriovenous Grafts (ecAVG) for Complex Vascular Access – A Healthy Alternative to Central Venous Catheters (CVC) Am J Transplant. 2017;17 (suppl 3).

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