Insertion of short introducer sheaths into a polyurethane vascular access graft for immediate hemodialysis access.

While native AV fistulae are considered the 'gold standard' for hemodialysis patients in need of long-term access, synthetic grafts are the best option for patients who are not candidates for an AV fistula. While AV fistulae should be allowed to mature for 3 - 4 months prior to cannulation, PTFE grafts may be cannulated 14 days after placement. Despite the benefit of earlier cannulation in PTFE graft recipients compared to AV fistulae patients, one critical limitation is that immediate post-operative cannulation is not possible.

Creation of native arteriovenous fistulas with interrupted anastomoses using a self-closing clip device - one clinic's experience.

The nitinol U-CLIPTM Anastomotic Device (Coalescent Surgical, Inc., Sunnyvale, CA) is a self-closing penetrating vascular clip that reduces suture management and eliminates knot tying, thus enabling rapid and precise interrupted suture placement and facilitating creation of an optimal vascular anastomosis. This report describes the use of U-CLIP devices in the surgical creation of native arteriovenous fistulas in 68 chronic hemodialysis patients.

Bridging to a high flow upper arm native fistula for hemodialysis with the LifeSite Hemodialysis Access System.

Permanent vascular access for chronic hemodialysis requires a reliable structure with adequate blood flow. Endogenous arteriovenous (AV) fistulas offer the best outcomes, but standard radiocephalic fistulas are not always feasible. A reliable alternative is a transposed basilic vein-brachial artery AV fistula, which offers a number of advantages over synthetic AV grafts.

Subcutaneous implantation of the LifeSite Hemodialysis Access System in the femoral vein.

Cannulation of the femoral vein is often necessary to provide immediate vascular access for hemodialysis patients in whom a functional permanent access is not available or in patients who have exhausted other access options. Femoral placement of dialysis catheters is typically short term - days, not months - and is associated with high rates of infection, occlusion, recirculation and intervention as well as a high risk of catheter dislodgment. A new, fully subcutaneous vascular access device - the LifeSite(R) Hemodialysis Access System (Vasca, Inc.

Successful treatment of a LifeSite Hemodialysis Access System pocket infection with large-volume kanamycin solution irrigation.

Bridge devices-dialysis catheters and subcutaneous access devices-play a critical role in increasing the placement of arteriovenous (AV) fistulas by providing hemodialysis vascular access while AV fistulas mature. The LifeSite Hemodialysis Access System (Vasca Inc, Tewskburg, MA), a fully implantable, subcutaneous dual valve access system, has been shown to have lower complication rates, higher blood flow rates, and better long-term device survival than conventional tunneled hemodialysis catheters, indicating it may better meet the requirements for optimally bridging to a fistula. This case study of a 48-year-old black man undergoing chronic hemodialysis for renal failure because of insulin-dependent diabetes describes a simple approach for resolving localized pocket infections associated with the LifeSite System by drip irrigation of the valves and tissue pockets with an antibiotic solution.