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Explantation rates and failure mechanisms in early cannulation grafts: A comparative study between Flixene and Gore
Andrea Gattuso1, Marco Tadiello1, Anna Maria Pisacreta2
1Vascular Surgery Unit, ASST Fatebenefratelli-Sacco, Milan, Italy.
Background:
Early cannulation arteriovenous grafts (ecAVGs) are increasingly used to reduce catheter dependence in hemodialysis patients, but device-specific complications remain a concern. This study aimed to compare explantation rates, timing, and mechanisms of failure between Flixene and Gore Acuseal grafts.
Methods:
We conducted a retrospective observational study including patients undergoing prosthetic vascular access implantation. Patients were stratified according to graft type (Flixene vs Gore Acuseal). The primary outcome was graft explantation rate. Secondary outcomes included time to explantation, overall complication rate, and causes of failure. Statistical analyses included chi-square/Fisher's exact tests, Kaplan-Meier survival analysis with log-rank testing incorporating full follow-up data with appropriate censoring, and multivariable logistic regression for infection-related explantation.
Results:
A total of 69 grafts were analyzed (30 Flixene, 39 Gore Acuseal). Gore Acuseal grafts showed a significantly higher explantation rate (48.7% vs 16.7%, p = 0.006). Kaplan-Meier survival analysis incorporating individual follow-up durations with appropriate censoring revealed significantly different graft survival curves between groups (log-rank p = 0.039). Median graft survival was 39 months for Gore Acuseal; median survival was not reached for Flixene within the observation period. Structural failure was the predominant cause of explantation in both groups. Complication patterns differed significantly: delamination was more frequent in Gore Acuseal grafts (30.8% vs 3.3%), whereas pseudoaneurysm was relatively more common in Flixene grafts (13.3% vs 10.3%; p = 0.015). Infection-related explantation occurred only in the Gore Acuseal group but was not statistically significant.
Conclusions:
Gore Acuseal grafts are associated with higher complication and explantation rates compared to Flixene. When analyzed with appropriate survival methodology, time to failure also differs significantly between devices. Distinct patterns of structural complications suggest that graft material and design influence both durability and mechanisms of failure. Further prospective studies are needed to confirm these findings and guide graft selection.
