While native AV fistulae are considered the 'gold standard' for
hemodialysis patients in need of long-term access, synthetic grafts are the best option for patients who are not candidates for an AV
fistula. While AV fistulae should be allowed to mature for 3 - 4 months prior to cannulation,
PTFE grafts may be cannulated 14 days after placement. Despite the benefit of earlier cannulation in
PTFE graft recipients compared to AV fistulae patients, one critical limitation is that immediate post-operative cannulation is not possible. The self-sealing nature of the
polyurethane Vectra(R) Graft overcomes the time restriction until first cannulation, allowing much earlier vascular access than conventional
PTFE grafts. We describe here a procedure for insertion of 5-French DialEasetrade mark Introducer Sheaths into the
Vectra Graft for immediate, post-operative
hemodialysis access. This procedure eliminates time restrictions until first cannulation of the
Vectra Graft; the sheath's large diameter sideport ensures high flow for efficient
hemodialysis. Moreover, insertion of the sheath into a new or existing
Vectra Graft provides vascular access for inspection of the graft anastomoses, angiography, angioplasty, venography, and declotting procedures. The post-operative introduction of DialEase Sheaths into a
Vectra Graft for immediate
hemodialysis was successfully performed in 35 patients. All patients then immediately received high-flow
hemodialysis (400 - 500 ml) with venous pressures < 125 mmHg and negative arterial pressure ~100 mmHg. To date, there have been no
infections, immediate graft
thrombosis or other complications associated with this procedure, and all patients have remained free of anastomotic problems. (The Journal of Vascular Access 2003; 4: 62-7).