A Safer, Longer-Lasting Approach to "Vascular Graft" Procedure
A team of physicians at DMC Harper University Hospital announced yesterday that it has successfully treated several patients with a new high-tech "vascular graft" that significantly reduces the risk of trauma to blood vessels used in connecting patients to the kidney dialysis machines that are essential to protecting their health.
The new vascular graft device – a specially engineered plastic tube that links veins to arteries to form a "bridge" between them as part of maintaining a safe and long-lasting connection between patient and kidney dialysis machine – is especially effective because it doesn't require suturing blood vessels, as happens in more traditional "venous anastomosis" surgical procedures, according to kidney specialists at the DMC.
Recently approved by the FDA for use in the United States, the "Flixene IFG" allows the connection between vein and artery (a key step in creating the "bridge" between patient and dialysis machine) to be made via the specially engineered plastic tube, thus eliminating the need for sewing the blood vessels together.
"The good news for kidney patients is that the use of this new vascular tool means it is no longer necessary to sew the graft into place," said Yevgeniy Rits, M.D., the vascular surgeon who has directed the Harper Dialysis Access Center (DAC) since its creation two years ago. "Because there is less trauma to the blood vessels involved, there is less chance that the graft will fail."
Until now, the sewn areas of the blood vessels in vascular grafts have often been the areas where they fail. But because the new Flixene IFG doesn't require any sutures at all, it seems likely to last much longer than the sewn grafts of the past.
"At the Harper DAC, we're encouraged by the fact that we are one of the first kidney care facilities in the country to make this powerful new tool available to patients."
The Dialysis Access Center at Harper University Hospital, unique in Michigan, is now helping more than 600 patients a year to maintain the vascular access required for successful linkage to kidney dialysis machines.
In the Detroit area, where diabetes-linked Chronic Kidney Disease (CKD) is a major public health problem, the two-year-old Harper program is saving an ever-increasing number of lives by providing the tools and specialized care that kidney patients need to maintain safe, healthy access to dialysis over the long term. With yesterday's announcement, the program "has gained another very important tool," said Dr. Rits.
The problem of creating and then protecting access to dialysis is especially acute in Detroit, where an estimated more than one-half of Michigan's current 12,000 kidney dialysis patients now live.
For these urban dialysis recipients – most of whom develop CKD as a result of severe diabetes, also a major pubic health threat in Detroit – establishing and then protecting a continuing "lifeline" that permits safe blood-flow between the dialysis machine and the patient's cardiovascular system is crucial to a successful outcome.
Because many patients with severe CKD will eventually require a kidney transplant, it's critically important for them to maintain their access – via several types of surgical procedures designed to help create an open pathway in the body between the bloodstream and the dialysis machine – until a healthy new kidney can be obtained from a donor.
At Harper, the Dialysis Access Center (DAC) brings together a wide array of high-tech medical tools and clinical specialists who can combine their skills and knowledge to provide custom-tailored, ongoing care for each individual patient.
"When it comes to providing the best possible care for a kidney patient, the key is being able to coordinate every aspect of that care at a single location," said Rits.
"For many CKD patients, good access to the dialysis machine is absolutely essential," he added. "Without it, the chances for a long-term successful outcome are greatly reduced. In addition, the possibility of eventually being able to undergo a successful kidney transplant is much smaller for those who lose the vital 'lifeline' which permits effective dialysis over an extended period of time."
Because the DAC is the only hospital-based facility of its kind in Michigan, the clinical specialists there can bring together all the tools they need to "take ownership" of each kidney patient's "access lifeline" to dialysis, he said. "The new vascular graft we have just introduced will help us achieve that goal," he added, "because it's a major step forward in protecting access to the kidney machine over the long term.
"Also, because our program is based at the hospital, we can maintain the complete, detailed history – including photographs, charts, diagnostics and all the rest – that is essential for monitoring each patient's specific care over time."
"That's a huge advantage, when it comes to making sure the patient is being monitored and followed at every stage of dialysis care, all the way through kidney transplant, should that particular therapy be required."
The DAC provides a comprehensive team of multidisciplinary experts that includes nephrologists (kidney specialists), general surgeons, vascular surgeons, interventionists and nurses, all of whom are dedicated to giving patients complete and safe access to dialysis care.
The DAC also provides continuing cardiovascular care, inpatient and outpatient services, a hypertension program and kidney transplant services to all kidney patients who require them.
In order to provide the best continuing access to dialysis, the DAC relies on a variety of procedures designed to establish a permanent connecting-point that will allow patients to link up with a dialysis machine whenever required.
There are two basic types of access-establishing procedures. One of them, known as a "Fistula Procedure," connects a vein (typically located in the patient's arm) with a nearby artery. This bridge between the two – permanently maintained beneath the patient's skin – then provides a safe and reliable entry point for the needle-fronted line that will carry the patient's blood through the dialysis machine, so that it can be cleaned of waste products and then returned to the patient's own bloodstream.
The second type of dialysis access is achieved via a tube (or "catheter") that is inserted into a large vein in the neck, chest or groin and then connected to the dialysis machine.
Because the catheter approach presents a higher rate of infection, many kidney specialists prefer to use the Fistula Procedure.
Dr. Rits also noted that the DAC is providing an important public-health benefit in Detroit, where diabetes-linked kidney disease has long been a chronic health problem.
"I think what's really significant about our program is that it's targeted to the thousands of Detroit-area patients who have an urgent need to maintain safe, healthy access to kidney dialysis," he said.
"Meeting the needs of that population is extremely important to us at Harper – which is why we've created the only hospital-based program in Michigan designed to help achieve continuing access to dialysis for patients with kidney disease."