Two year follow-up results for Spiral Flow Grafts in AV Access

Presented at the 37th Charing Cross International Symposium, April 2015, London, UK Prim. Univ.-Doz. Dr. Wolfgang J. Hofmann, Department of Vascular Surgery, Landeskrankenhaus, (LKH) Feldkirch, Austria

Introduction
The AV access strategy at LKH Feldkirch focusses primarily on utilising native fistula and Duplex mapping of the upper extremity is undertaken to identify the most appropriate approach.

AV grafts are only used in patients not suitable for a native fistula.

Conventional AV grafts typically require one to two revisions per year.

Methods
Since September 2010, a series of 16 grafts have been implanted in 15 patients. All patients have had previous
surgery (mean of 4.3 previous procedures (0-24).  Mostly loop grafts in the forearm are utilised.
• 11 loop forearm
• 2 loop upper arm
• 2 straight upper arm
• 1 loop thigh
• 4 graft occlusions / two successful thrombectomies
• 4 graft explants (2 due to steal, 2 due to infection)

Results
The results from 16 Spiral FlowTM AV Grafts, implanted between September 2010 and August 2013 were reviewed. Median follow up was 22 months and all grafts were Duplex scanned every three months to confirm the presence of Spiral Flow. Additional scans were performed if there was any suspicion of graft failure.

At 22 months, the primary rate was 72%; secondary patency was 85.5%

The results were compared to a series of 79 conventional PTFE grafts implanted by Dr Hofmann between January 2005 and December 2009. A Kaplan-Meier analysis highlighted primary patency rates at 18 months of 72% for Spiral FlowTM and 36.7% for conventional PTFE grafts. (P=0.01)

Conclusion
Changing the flow pattern at the venous anastomosis of AV grafts using the Spiral Flow Technology seems to be a simple but valuable tool in order to improve patency rates of PTFE AV grafts