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

ASDIN 7th Annual Scientific Meeting � 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 � T he o b je c tive o f this study wa s to the g ra ft tha t: summa rize the re sults o f o ne c e nte rs 1) Pre ve nts pa lpa tio n o f the re sults with the g e la tin-c o a te d PT g F E g ra ft g 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 � T he study wa s re tro spe c tive in na ture fo r c o rre c tio n 3) Re q uire d e xpla nta tio n o f the g ra ft � Co mme rc ia lly a va ila b le g e la tin-se a le d � All pa tie nts unde rwe nt ultra so und g ra fts in 6mm a nd 4mm-7mm size s we re va sc ula r ma pping to a sse ss the ir o ptio ns use d fo r a n a uto g e no us AVF � Minimum ve in size o f 3.0mm wa s use d to Mi i i i f 3 0 d t re c e ive the ve no us o utflo w � 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 � I f the inflo w a rte ry wa s < 4.0 mm the 4-7mm ve no us de vic e s o r ste rno to my 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 1

ASDIN 7th Annual Scientific Meeting � Bra c hia l ple xus b lo c k a ne sthe sia � 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 � Ma nufa c ture r’ s I nstruc tio ns fo r Use le t it to dry o ut a fte rwa rds. fo llo we d c a re fully � Avo id e xc e ssive te nsio n o n pro sthe sis, mo de ra te id i i h i d te nsio n o nly. � Swo rd a nd She a th tunne lle r utilize d � Use a ppro pria te le ng th o f g ra ft to a vo id stre ss a t � Suturing do ne with 6-0 PT F E suture 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 � I ntra o pe ra tive vo lume flo ws me a sure d the tunne l. Pre ssure o n g ra ft ma y c a use b lo o d b y duple x a sse ssme nt 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. � Ne ve r fo rc e sa line o r b lo o d into the g ra ft unde r pre ssure � 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 � Dista l (ve no us) c la mp a lwa ys re mo ve d suppo rt po rtio n. Ma y da ma g e g ra ft. first � 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 . • 11 se ro ma s we re de te c te d in � 30 pro c e dure s we re pe rfo rme d o n 28 30 se a le d PT F E g ra fts 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 2

ASDIN 7th Annual Scientific Meeting No Seroma Total χ 2 (1) 100% seroma 90% 80% Group A: 6mm Gelatin 10 10 20 70% 4.59* Sealed Graft 60% ( (50.0%) ) ( (50.0%) ) 50% 90% No Se r oma 40% Group B: 4-7mm Tapered 9 1 10 Se r oma Gelatin Sealed Graft 30% (90.0%) (10.0%) 50% 50% 20% 10% Total 19 11 30 10% 0% (63.3%) (36.7%) Gr oup A: 6mm Gr oup B: 4-7mm T a pe r e d Ge la tin Se a le d Gr a ft Ge la tin Se a le d Gr a ft Note . The results were determined to be significant by both the Pearson chi-square test and Fisher ’ s exact test. * p < .05. Statistically significant with Fisher’s Exact Test P=.049 Gro up Sta tistic s Gr oup N Me an Std. Std. E r r or Se r oma N Me an Std De viation Std E r r or (ml/ min) (ml/ min) de viation de viation Me an Me an Me an 6mm 19 1098.95 605.919 139.007 No 18 1034.61 549.335 129.480 4-7mm 10 930.00 510.476 161.427 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 3

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ASDIN 7th Annual Scientific Meeting 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 5

ASDIN 7th Annual Scientific Meeting � 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 ll s. Supe r-hydro pho b ic Hydro pho bic pro pe rtie s lo st in a we e ping g ra ft lo tus le a f � With 11 c linic a lly sig nific a nt se ro ma s o ut o f 30 impla nts, the g e la tin-se a le d PT F E Eric D. Ladenheim M.D. va sc ula r pro sthe sis is no t the ide a l dia lysis g ra ft g ra ft. Nathan B Chadwick PA-C Nathan B. Chadwick PA-C Theresa M. Dunaway RN, BSN, CCRP Sid Agrawal M.D. Craig Lum D.O. 6