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[Dialock--an alternative to Permcath and access graft]
M Hessinger1, S Zitta, H Holzer
1Klinische Abteilung für Gefässchirurgie, Universitätsklinik für Chirurgie, Graz.
Insights
The Dialock vascular access system offers a safer alternative for hemodialysis patients, showing lower infection and complication rates compared to grafts and central venous catheters. This innovative system provides a reliable solution for complex cases needing long-term vascular access.
Area of Science:
- Nephrology
- Vascular Surgery
- Medical Devices
Background:
- Hemodialysis requires adequate vascular access, which is challenged by an aging patient population with increased comorbidities.
- Grafts and central venous catheters (CVCs) are common but associated with significant complications.
- The Dialock system is a subcutaneously implantable device designed to combine benefits of central venous access with percutaneous puncture for hemodialysis.
Purpose of the Study:
- To evaluate the safety and efficacy of the Dialock vascular access system in hemodialysis patients.
- To compare the performance of the Dialock system against traditional vascular access methods like grafts and CVCs.
Main Methods:
- A prospective study involving 26 Dialock system implantations over 30 months.
- Comparison with a control group of 22 hemodialysis patients with 47 vascular accesses and analysis of 110 patients with grafts.
- Data collection focused on infection rates, malfunctions, and need for interventions (PTA, thrombectomies).
Main Results:
- Dialock demonstrated significantly lower infection rates (exit site and bloodstream) per 1,000 hemodialysis access days compared to grafts and CVCs.
- The incidence of malfunctions was lower with Dialock than with CVCs.
- Grafts required more frequent interventions like percutaneous transluminal angioplasty (PTA) or thrombectomies compared to Dialock.
Conclusions:
- The Dialock access system is a safe and less complicated vascular access device for complex hemodialysis patients.
- With low infection and complication rates, Dialock presents a viable alternative to permanent CVCs and grafts.
- Careful application of the Dialock system is recommended for optimal outcomes in hemodialysis vascular access.
Purpose:
An adequate vascular access is the precondition for a well-functioning hemodialysis. Due to the increasing age and the rising co-morbidity of hemodialysis patients the number of those with grafts or central venous catheters (CVC) is steadily growing. The Dialock vascular access system provides a subcutaneously implantable device for hemodialysis that combines the advantages of central venous access with percutaneous puncture.
Patients And Methods:
Over a period of 30 months 26 Dialock vascular access systems were implanted at our department. 17 patients were male, 9 patients female. In 11 patients the implantation of this system was indicated for internal medicine reasons. In 15 long-term hemodialysis patients implantation was carried out as ultimate solution because of persisting vascular access problems. In a comparable control group of 22 hemodialysis patients 47 vascular accesses were registered within the same period. In parallel, another 110 patients with grafts implanted at our department at that time but not put to hemodialysis at our clinic were analysed.
Results:
In a comparable number of access days the graft and the central venous catheter showed a considerably higher infection rate (Exit site + blood stream infection) per 1,000 hemodialysis access days than the vascular access device. The rate of malfunctions with or without subsequent lysis was higher using the CVC than when applying Dialock or graft. Angiographies with percutaneous transluminal angioplasty (PTA), or thrombectomies, respectively were significantly more often required with the graft than changes of catheter when using the vascular access system. More than half of the 110 patients observed at the same time, who had a graft implanted at our department without subsequent hemodialysis at our clinic had to undergo another surgical or radiologic intervention.
Conclusion:
The Dialock access system represents in our experience a safe and with careful application less complicated vascular access device for the complex hemodialysis patient. With comparatively low infection and complication rates the Dialock vascular access system serves as a good alternative to the permanent CVC (Permcath) as well as to the graft.
