Characteristics and Management of Dissection in Early Cannulation Arteriovenous Grafts

INTRODUCTION: Vascular access is critical for hemodialysis in patients with end-stage renal disease. Autogenous arteriovenous fistula is the first-line option, while arteriovenous grafts are an alternative for patients with poor native vascular conditions. Over the past decade, early cannulation arteriovenous grafts with a multi-layered structure have emerged, allowing cannulation within 24-72 h after implantation to meet urgent dialysis needs. However, this specific structure renders them susceptible to dissection, a unique complication. To date, no systematic review has summarized the characteristics and management of this complication, and this paper aims to address this gap. METHODS: The search was conducted in the PubMed database. Finally, seven case reports and one cohort study were included. FINDINGS: The diagnosis of dissection in early cannulation arteriovenous grafts mainly relies on Doppler ultrasound examination. Most reported cases involve Acuseal grafts, with dissections predominantly located between the middle and outer layers, and mostly on the anterior wall. It may be associated with balloon dilation, vascular sheath insertion, inappropriate puncture angle, and repeated joint movement. There is no standard treatment protocol. Available options include PTA, stent implantation, graft replacement, and conservative observation. Graft replacement yields the best primary patency rate. Stent implantation or graft replacement is recommended as the first-line treatment. DISCUSSION: Reports on dissection in early cannulation arteriovenous grafts remain scarce. The true incidence across different graft types, optimal treatment strategies, and long-term outcomes following various interventions have not been fully clarified, and further research should be conducted in the future.