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Proposal of a classification of cannulation damage in vascular access grafts based on clinical, ultrasound, and microscopic observations.
Franchin, Marco; Vergani, Barbara; Huber, Veronica; Leone, Biagio Eugenio; Villa, Antonello; Muscato, Paola; Cervarolo, Maria Cristina; Piffaretti, Gabriele; Tozzi, Matteo.
Afiliación
  • Franchin M; Vascular Surgery, University of Insubria, ASSTSettelaghi Universitary Teaching Hospital, Varese, Lombardy, Italy.
  • Vergani B; Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Lombardia, Italy.
  • Huber V; Unit of Immunotherapy of Human Tumors, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Lombardia, Italy.
  • Leone BE; Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Lombardia, Italy.
  • Villa A; Consorzio MIA, Microscopy and Image Analysis, University of Milan Bicocca, Monza, Lombardia, Italy.
  • Muscato P; Vascular Surgery, University of Insubria, ASSTSettelaghi Universitary Teaching Hospital, Varese, Lombardy, Italy.
  • Cervarolo MC; Vascular Surgery, University of Insubria, ASSTSettelaghi Universitary Teaching Hospital, Varese, Lombardy, Italy.
  • Piffaretti G; Vascular Surgery, University of Insubria, ASSTSettelaghi Universitary Teaching Hospital, Varese, Lombardy, Italy.
  • Tozzi M; Vascular Surgery, University of Insubria, ASSTSettelaghi Universitary Teaching Hospital, Varese, Lombardy, Italy.
J Vasc Access ; : 11297298241248263, 2024 Apr 28.
Article en En | MEDLINE | ID: mdl-38679815
ABSTRACT

INTRODUCTION:

Arteriovenous grafts (AVGs) serve as an alternative to native arteriovenous fistulas (AVFs) in the context of hemodialysis patient life planning. AVGs are more susceptible to developing outflow stenosis (due to intimal hyperplasia), thrombosis, and infections. However, an often overlooked contributor to AVG failure is cannulation damage. The objective of this paper is to assess the impact of cannulations on AVGs. We aim to establish a classification of AVG damage by comparing clinical data and ultrasound images with microscopic morphological findings obtained from explanted grafts. MATERIALS AND

METHODS:

This study is conducted at a single center. We included all patients who underwent AVG creation between 2011 and 2019. Comprehensive data on clinical history, follow-up, and complications were collected and reviewed. Duplex ultrasound (DUS) characteristics were documented, and all grafts explanted during the analysis period underwent optical microscopy evaluation. Finally, clinical data, along with DUS and microscopic findings, were integrated to derive a damage classification.

RESULTS:

During the study period, 247 patients underwent 334 early cannulation AVGs. The median follow-up duration was 714 days (IQR 392, 1195). One hundred eleven (33%) grafts were explanted. Clinical data and DUS findings were utilized to formulate a four-grade classification system indicating increasing damage.

CONCLUSION:

Cannulation damage alone does not solely account for AVG failure. It results from a biological host-mediated process that promotes the growth of intimal hyperplasia at the cannulation sites. This process is not clinically significant within the initial 2 years after AVG creation.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Vasc Access Asunto de la revista: ANGIOLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Vasc Access Asunto de la revista: ANGIOLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Estados Unidos