Comparison of two early cannulation grafts for hemodialysis

Early cannulation grafts allow patients with end-stage renal disease to avoid the discomfort, inconveniences, and bloodstream infections associated with central vein catheters (CVCs). Flixene graft and Acuseal graft are both approved by the Taiwan Food and Drug Administration; however, comparative data on complications, patency rates, and interventions to maintain patency remain limited.

From August 2021 to September 2023, our center performed 82 Flixene and 70 Acuseal grafts. We retrospectively reviewed their early complications, patency rates, time to first cannulation, and CVC usage. Primary patency (PP), assisted PP, secondary patency (SP), and access survival were assessed via Kaplan-Meier survival curves and log-rank tests.

The Flixene and Acuseal groups had similar demographics and graft locations. During mean follow-up periods of 418 ± 266 days for Flixene and 287 ± 151 days for Acuseal, Acuseal showed higher rates of early cannulation site bleeding (P < .001) and graft delamination (10% vs 0%, P < .001). There were no significant differences in 1-, 3-, 6-, and 9-month PP, assisted PP, and access survival between the groups, but Acuseal had significantly worse SP compared with Flixene (P < .001). Reduced SP was associated with severe recurrent stenosis and delamination, requiring endovascular or surgical revision. Time to first cannulation was similar (17.5 vs 17.3 days), with CVC-free rates of 20.7% vs 20% and CVC usage durations of 29.2 vs 33.6 days (P = .67).

Acuseal grafts did not exhibit superior hemostasis or patency compared with Flixene. Delamination and severe recurrent stenosis posed significant issues, particularly impacting SP. Challenges include limited experience with Acuseal grafts, nonreimbursement policies in Taiwan, and staff familiarity with the product.