Lessons learned from the DIASTAT vascular access graft

Background The vascular community continues to search for the ideal vascular access graft that will allow early cannulation and avoid temporary central venous catheters. Methods This is a review of the Cranley Surgical Associatesʹ experience with the use of the Gore-Tex DIASTAT (W.L. Gore & Associates, Inc., Flag-staff, Arizona) vascular access graft in 20 patients compared with 20 control patients matched for age, sex and risk factors. Results Although the DIASTAT graft is touted for early accessibility and decreased need for central venous access, that was not found to be the case as 14 patients in the DIASTAT group received temporary access catheters. There was significantly more edema in the DIASTAT patients (P=0.0048). Comparing the time to the first thrombosis or to revision revealed an average of 18 weeks for the DIASTAT group and 56 weeks for the control group. The length of time to thrombosis or revision was significantly longer in the control group (P=0.0058). Comparison of the number of weeks of function and serviceability of the grafts revealed the average DIASTAT graft functioned for 34 weeks and that of the control group for an average of 70 weeks (P=0.0131). Comparison of the two groups showed a significant increase in early thrombotic events (<90 days) in the DIASTAT grafts (P=0.0013). Conclusions The DIASTAT vascular access graft does not appear to be the ideal hemodialysis access graft.