Spiral Flow™ AV Access Graft – Information for Interventionists

Your patient has a Spiral FlowTM AV Access Graft for their lifeline.

The Spiral Flow™ AV Access Graft has some special features that are unique from all other ePTFE dialysis grafts that are important for you to know about.

Special Features of the Spiral Flow™ Graft

VASCULAR FLOW - DIAGRAM OF GRAFT 2On the venous end of the graft is an injection moulded helical ridge that remodels the blood flow inside the graft into the normal pattern of blood flow. It is called a SPIRAL FLOW™ INDUCER. You will not be able to feel it.

Spiral Flow™ Grafts produce little or no turbulence across the venous anastomosis.  The thrill may be less intense than standard grafts, and the bruit may be difficult to detect. Use ultrasound to determine graft patency.

On the outside of the graft near the venous end just over the leading edge of the SPIRAL FLOW™ INDUCER is a raised ridge called an INDUCER INDICATOR RING. It can be palpated through the skin.

 

VASCULAR FLOW - Diagram ARM

 

Thrombectomising the Spiral Flow™ Graft

In addition to surgical thrombectomy, many percutaneous techniques are suitable for use on the Spiral Flow™ Graft to include; pulsed spray thrombolysis, mechanical balloon thrombectomy, catheter directed thrombolysis and brushes.

For percutaneous thrombolytic procedures, access the graft in a criss-cross manner.

 

VASCULAR FLOW - Diagram ARM 2

 

When embolectomy or balloon angioplasty catheters are used within the lumen of the graft, the inflated balloon size MUST match the inner diameter of the graft. Angioplasty balloons must not be used within the spiral flow inducer segment of the graft as radial expansion of the graft internal diameter may remove the SLF™ technology. Angioplasty can be safely performed proximal and distal to the SLF™ technology inducer.

Perform an outflow venogram

If the outflow tract is suitable, perform the thrombus extraction procedure per its standard instruction.

When withdrawing balloons or brushes from the venous side, the INDUCER INDICATOR RING is a reliable marker that indicates the area of full graft internal diameter from the segment containing the SPIRAL FLOW INDUCERRemove the arterial plug with an embolectomy balloon.

Post Treatment Imaging of the Spiral Flow™ Graft

Upon completion of thrombolysis and thrombectomy, contrast enhanced imaging of the venous outflow all the way to the right atrium should be performed to identify any significant lesions.

In addition to the contrast enhanced imaging, we strongly recommend a transverse colour Doppler ultrasound image of the SLF™ Graft venous anastomosis. Observing the “red/blue split” indicating the presence of normal flow ensures the SPIRAL FLOW INDUCER is free of thrombus and performing as designed.

Balloon Angioplasty of the Spiral Flow™ Graft

Balloon angioplasty of the Spiral Flow™ Graft should only be done in areas outside the SPIRAL FLOW INDUCER segment.

Radial expansion of the graft wall could cause the inducer to not create spiral flow, rendering the grafts performance equal to that of other grafts.

Radial expansion may also cause the polyurethane bead that creates the SPIRAL FLOW™ INDUCER to separate from the outside of the graft – causing loss of the internal form, rendering the graft’s performance equal to that of other grafts.

Post Treatment Imaging of the Spiral Flow™ Graft

We strongly recommend a transverse colour Doppler ultrasound image of the SLF™ Graft venous anastomosis. Observing the “red/blue split” indicating the presence of normal flow insures the SPIRAL FLOW INDUCER is free of thrombus and performing as designed.