Single Asian Centre Experience Using the Flixene™ Early Cannulation Graft for Haemodialysis Access Creation

Abstract Aim To review the efficacy of the Flixene™ (Atrium™, Hudson, NH, US) haemodialysis arterio-venous graft (AVG) in a multi-ethnic Asian cohort of patients with end-stage renal failure (ESRF). Primary outcome was graft primary patency rate and secondary endpoints included graft usability, time to cannulation, re-interventions required for access salvage, complications and patient mortality. Methods Single-center, single arm, multi investigator non-randomized retrospective study. ESRF patients who underwent Flixene™ graft implantation over a two-year period (January 2017 - December 2018) were included to allow at least one-year follow-up. Demographics, procedural and follow-up data were collected from the hospital electronic medical records. Results 48 patients (49 AVG) were included. There were 24 (50%) males; mean age 63.7 (IQR 58.2-71.3) years. Technical success rate was 45/49 (91.8%); 4/49 (8.2%) AVG created did not reach cannulation. 11/49 (22.4%) and 28/49 (57.1%) achieved cannulation within one and 2 weeks respectively. 6- and 12- month primary patencies were 33.5% and 19.6% respectively. Primary-assisted patency rates were 46.6% and 29.6% at the same time intervals. Secondary patency rate was 77.6% and 63.9% at 6- and 12 months respectively. There were 6 (12.2%) graft infections requiring explant and one-year mortality was 14%. Conclusions Our experience with the Flixene™ early cannulation graft is comparable to other AVGs in terms of patency and infection rates. However, early cannulation rates are lower than in other case series.