Abstract: Objectives To report the safety and effectiveness of the Gore Acuseal Graft used as a lower extremity prosthetic vascular access for chronic hemodialysis patients who have exhausted upper extremity vascular access or have central venous stenosis. Methods Between December 2016 and May 2017, 15 patients who underwent implantation of the Gore Acuseal prosthetic AV access were included in the study. The graft configuration was superficial femora-saphenous for all patients. Follow-up studies including the time to first cannulation, patency rate, seroma rate, access thrombosis, steal syndrome, pseudo-aneurysm and infection were recorded. Results Graft implantation was technically successful in all 15 patients. No patient was lost during a mean follow-up time of 3.6±1.6 months (1.7～6 months). Mean time to first cannulation was 136.8±97.2 hrs (24～384 hrs). Primary functional potency rate was 100%. Primary blood flow rate was 200～230 ml/min. First puncture time was 136.8±97.2 hrs (24～384 hrs), and average follow-up period was 3.6±1.6 months (1.7～6.0 months). Seroma, thrombosis, pseudo- aneurysm and graft infection were never observed. Steal syndrome occurred in one patient and the graft was removed. Cannulation is easier than other types of regular prosthetic access reported by nurses. Cannulation site usually stop bleeding in 15 minutes with pressure on the site, and no hematoma was observed. Central venous catheter was removed, or the dysfunctional fistula was ligated at early postoperatively stage in 12 patients. Central venous stenosis complications were not observed. Follow-up found that blood flow rate was greater than 250 ml/min in all patients. Conclusion Lower extremity Gore Acuseal graft implantation was safe and effective with less complication. It can be widely applied for chronic hemodialysis patients who have exhausted upper extremity vascular access or have central venous stenosis.

Key words: Early cannulation, Gore Acuseal, Prosthetic vascular access, Lower extremity, Hemodialysis