Matteo Tozzi
Current Position
.Chief Vascular surgery Unit ASST-Settelaghi Varese
.Associate Professor Vascular Surgery University of Insubria
University of Insubria/ ASST-Settelaghi
Abdominal Aorta & Aortic iliac Session

Topic: Application of early cannulation graft in dialysis access surgery Acuseal


Arterovenous grafts (AVG) represents an option in the setting of haemodialysis patient life-plan. Although recent literature, and international guidelines, reconsidered AVF superiority over AVG in terms of complications, it should be emphasised that AVG are more prone to develop outflow stenosis (due to intimal hyperplasia), thrombosis, and infections. Nevertheless, a miscalculated source of AVG failure is represented by cannulation damage and consequent graft depletion.
We aim to present paper is to assess the effects of cannulations on AVG. We intend to evaluate the durability of the graft, comparing clinical data and ultrasound images to microscopical morphological findings obtained on explanted grafts.

Methods This is a single centre, prospective, observational cohort study. In the period from January 2011 to December 2019 we considered all patients that underwent AVG creation with early cannulation graft Acuseal . All clinical, follow-up and complications data were collected and reviewed. Arteriovenous graft Doppler ultrasound (DUS) characteristics were noted. All the graft explanted during the analysis period were evaluated by optical microscopy. Finally, clinical data together with DUS and microscopic findings were matched to obtain a classification of damage.

In the study period, 247 patients underwent 334 early cannulation AVG. The median duration of the follow-up was 659 days (IQR 339, 1195). One hundred eleven (33%) grafts were explanted. Graft survival was 87%, 75% and 51% at 1, 2 and 5 years, respectively. Clinical data and DUS findings permitted to create a 4-grades classification of increasing damage. Microscopy confirmed the

During the follow up, AVG were evaluated with DUS assessing the progression of cannulation damage. We divided the main lesions into four classes corresponding to four time intervals.
We can conclude by affirming that haemodialysis graft exhaustion is a process involving two phases first a biological phase of graft integration and second a mechanical phase du to cannulation damage.