ASDIN 7th Annual Scientific Meeting Pe rig ra ft se ro ma ha s b e - - PDF document

ASDIN 7th Annual Scientific Meeting 1

Pe rig ra ft se ro ma ha s b e e n a re la tive ly ra re

c o mplic a tio n o f PT F E g ra fts, o c c urring in 1-4% o f impla nts.

A g e la tin-c o a te d PT

F E g ra ft ha s b e e n ma rke te d fo r dia lysis a c c e ss with c la ims o f re duc e d suture line b le e ding a nd g ra ft we e ping .

We tria le d this g ra ft a nd fo und 11 sig nific a nt

se ro ma s o ut o f 30 impla nts: ma ny mo re pe rig ra ft se ro ma s tha n we e xpe c te d.

A fluid c o lle c tio n a ro und the g ra ft tha t:

1) Pre ve nts pa lpa tio n o f the b o unda rie s o f the g ra ft b o unda rie s o f the g ra ft

(i.e . c a using diffic ulty with g ra ft c a nnula tio n)

2) Re q uire d furthe r surg e ry fo r c o rre c tio n 3) Re q uire d e xpla nta tio n o f the g ra ft

T

he o b je c tive o f this study wa s to summa rize the re sults o f o ne c e nte rs re sults with the g e la tin-c o a te d PT F E g ra ft g g

T

he study wa s re tro spe c tive in na ture

All pa tie nts unde rwe nt ultra so und

va sc ula r ma pping to a sse ss the ir o ptio ns fo r a n a uto g e no us AVF

Co ntra st ve no g ra phy wa s do ne in a ll

pa tie nts with a histo ry o f prio r c e ntra l ve no us de vic e s o r ste rno to my

Co mme rc ia lly a va ila b le g e la tin-se a le d

g ra fts in 6mm a nd 4mm-7mm size s we re use d Mi i i i f 3 0 d t

Minimum ve in size o f 3.0mm wa s use d to

re c e ive the ve no us o utflo w

I

f the inflo w a rte ry wa s < 4.0 mm the 4-7mm ta pe re d g e la tin-se a le d g ra ft wa s use d

I

f the inflo w a rte ry wa s >= 4.0 mm the 6mm g e la tin-se a le d g ra ft wa s use d

ASDIN 7th Annual Scientific Meeting 2

Bra c hia l ple xus b lo c k a ne sthe sia Ma nufa c ture r’ s I

nstruc tio ns fo r Use fo llo we d c a re fully

Swo rd a nd She a th tunne lle r utilize d Suturing do ne with 6-0 PT

F E suture

I

ntra o pe ra tive vo lume flo ws me a sure d b y duple x a sse ssme nt

Use a tra uma tic c la mps witho ut e xc e ssive fo rc e . So a k in sa line no lo ng e r tha n 5 minute s a nd do n’ t

le t it to dry o ut a fte rwa rds. id i i h i d

Avo id e xc e ssive te nsio n o n pro sthe sis, mo de ra te

te nsio n o nly.

Use a ppro pria te le ng th o f g ra ft to a vo id stre ss a t

a na sto mo sis.

Do n’ t fill g ra ft with b lo o d b e fo re pa ssing it thro ug h

the tunne l. Pre ssure o n g ra ft ma y c a use b lo o d c o mpo ne nts to pa ss thro ug h g ra ft c a using se ro ma

Ne ve r c ut o r o pe n a g ra ft to fo rm a surg ic a l pa tc h. Do n’ t re mo ve o ute r e PT

F E wra p o n wra ppe d g ra fts.

Pre c lo tting no t ne c e ssa ry to pre ve nt g ra ft

b le e ding .

Do no t re mo ve o r c a nnula te the c e ntra l spira l

suppo rt po rtio n. Ma y da ma g e g ra ft.

E

xte rna lly suppo rte d g ra fts ha ve le ss g e la tin c o ve ra g e unde r the suppo rt. Whe n suppo rt is re mo ve d, the unde rlying g ra ft c a n b e ha ve like unse a le d e PT F E . Ne ve r fo rc e sa line o r b lo o d into the g ra ft

unde r pre ssure

Dista l (ve no us) c la mp a lwa ys re mo ve d

first

30 pro c e dure s we re pe rfo rme d o n 28

pa tie nts.( 2 pa tie nts ha d 2 g ra fts impla nte d)

We impla nte d 20, 6mm stra ig ht

g ra fts a nd 10, 4-7mm ta pe re d AV Gra fts.

5 we re pla c e d in fo re a rm a nd 25 in

the Uppe r a rm

• 11 se ro ma s we re de te c te d in

30 se a le d PT F E g ra fts

ASDIN 7th Annual Scientific Meeting 3

No seroma Seroma Total χ2(1) Group A: 6mm Gelatin Sealed Graft 10 (50.0%) 10 (50.0%) 20 4.59* ( ) ( ) Group B: 4-7mm Tapered Gelatin Sealed Graft 9 (90.0%) 1 (10.0%) 10 Total 19 (63.3%) 11 (36.7%) 30

• Note. The results were determined to be significant by both the Pearson chi-square test and Fisher’s exact test.

*p < .05.

60% 70% 80% 90% 100%

50% 90% 50% 10%

0% 10% 20% 30% 40% 50%

Gr

• up A: 6mm

Ge la tin Se a le d Gr a ft Gr

• up B: 4-7mm T

a pe r e d Ge la tin Se a le d Gr a ft No Se r

• ma

Se r

• ma

Statistically significant with Fisher’s Exact Test P=.049

Gr

• up

N Me an (ml/ min) Std. de viation

• Std. E

r r

• r

Me an Gro up Sta tistic s (ml/ min) de viation Me an 6mm 19 1098.95 605.919 139.007 4-7mm 10 930.00 510.476 161.427 Se r

• ma

N Me an Std De viation Std E r r

• r

Me an No 18 1034.61 549.335 129.480 Ye s 11 1050.64 633.161 190.905

6 pa tie nts ha d g ra fts e xpla nte d 2 pa tie nts c a nnula tio n de la ye d 2 mo nths 2 pa tie nts c a nnula tio n de la ye d 3 mo nths 1 pa tie nts ha d c a nnula tio n de la ye d 4

mo nths

ASDIN 7th Annual Scientific Meeting 4

ASDIN 7th Annual Scientific Meeting 5

Patie nt 02 OP Note Patie nt 02 We e k 5 Patie nt 02 We e k 5 Patie nt 02 We e k 5 Patie nt 02 We e k 5

ASDIN 7th Annual Scientific Meeting 6

e PT

F E is a line a r the rmo pla stic po lyme r. I ts po ro sity va rie s fro m 20-100 mic ro ns.

I

t is stro ng ly hydro pho b ic a ltho ug h this c a n b e a lte re d b y a pplic a tio n o f a lc o ho ls o ils b e a lte re d b y a pplic a tio n o f a lc o ho ls, o ils, Be ta dine o r pre ssure

Afte r c hro nic impla nta tio n a n infla mma to ry

re a c tio n e lic its tissue ing ro wth; ho we ve r, initia lly, the g ra ft is de pe nde nt o n its hydro philic pro pe rtie s to pre ve nt se rum fro m ultra filtra ting thro ug h the wa lls.

Supe r-hydro pho b ic lo tus le a f

Hydro pho bic pro pe rtie s lo st in a we e ping g ra ft

With 11 c linic a lly sig nific a nt se ro ma s o ut

• f 30 impla nts, the g e la tin-se a le d PT

F E va sc ula r pro sthe sis is no t the ide a l dia lysis g ra ft g ra ft.

Eric D. Ladenheim M.D. Nathan B Chadwick PA-C Nathan B. Chadwick PA-C Theresa M. Dunaway RN, BSN, CCRP Sid Agrawal M.D. Craig Lum D.O.