Q: How soon can Artegraft be accessed?
A: The approved time is 10 days after implant, but many dialysis units wait two to four weeks so the graft has a chance to incorporate in the subcutaneous tissue.
Q: How should the graft be cannulated with the fistula needle?
A: Think of Artegraft just as you would a fistula. Its collagen matrix is like an artery (or vein), thus it should be accessed in the same fashion as a native fistula, at a 25-30° angle. Do not push the needle too hard as it may exit the graft’s back wall and cause a hematoma.
Q: Can a clamp or blood pressure cuff be used on Artegraft?
A: No, as this may contribute to thrombosis.
Q: How is the Artegraft best cared for?
A: The graft is literally your "lifeline" and the highest degree of personal compliance and hygiene possible will help it to function properly. Refer to K-DOQI Guideline 14 for more information.
Q: What should the dialysis/caregiver know about Artegraft?
A: Inform them that you have a natural collagen graft; access the graft similar to a native fistula; and rotate the needle site each dialysis treatment so the graft lasts longer.
LISTED BELOW ARE SOME SIGNS TO WATCH FOR – ANYTHING YOU CONSIDER UNUSUAL SHOULD BE IMMEDIATELY DISCUSSED WITH THE NURSE OR DOCTOR:
- Bleeding that won’t stop
- Shortness of breath
- Loss of feeling in your hand/fingers
- Swelling of the arm or hand on the graft side
- "Ballooning" of the graft
- Redness or tenderness of the area
- Fever and/or chills
- Nausea or vomiting
Acute Care Questions
Q: What are the indications for use?
A: Artegraft is intended for use distal to the aorta as a segmental arterial replacement, as an arterial bypass, as an arteriovenous shunt where more conventional methods have proven inadequate, or as an arterial patch graft. The use of the Artegraft for femoropopliteal bypass should be reserved for those patients where the autologous saphenous vein is absent or inadequate. It is also not recommended for reconstruction across the knee joint. However, in the absence of other viable alternatives, the surgeon may well find the benefit-to-risk ratio warrants its use as an attempted limb salvage procedure.
Q: What is the primary contraindication?
A: Artegraft should not be used in venous or low pressure systems.
Q: What antibiotic is most commonly used in a prophylactic manner?
A: As with many prosthetic implants, Cefazolin or Vancomycin are commonly used.
Q: Is Artegraft human tissue?
A: No. The graft is made from the carotid artery of food source cattle. Many other implantable medical devices come from bovine sources. All material is certified by our suppliers to be BSE-free.
Q: What is the shelf life?
A: Three years from the date of manufacture. The expiration date is clearly shown on the package label.
Q: What suture should be used?
A: The most commonly used is 5-0 or 6-0 polypropylene in continuous suture, according to the surgeon's preference. Anastomotic clips (VCS & U-Clip) have also been effectively utilized.
Q: Is there any reaction after implant?
A: While any foreign material may cause a reaction, Artegraft is tested as non-antigenic, packaged sterile in its container.
Q: What manner is commonly used to thrombectomize Artegraft?
A: Thrombosed grafts can be salvaged by conventional means such a thrombectomy and patch angioplasty, or percutaneous lysis and balloon angioplasty.
Q: What is the reimbursement coding for Artegraft?
A: CPT is 36830, APC is 0088, HCPCS code is C1768.
Q: What tunneler can be used?
A: Most common stainless steel tunnelers can be used with Artegraft, e.g., bullet tip Kelly-Wick. It is not recommended that Artegraft be inserted and pulled through the lumen of a tunneling device.
Q: How is steal syndrome ameliorated?
A: Artegraft may be manually tapered during surgery to the appropriate native vessel millimeter size, and the arterial anastomosis can be easily narrowed with a running suture.
Q: Does Artegraft contain latex?
A: No. It is latex free.
Q: Why must the graft be soaked and flushed with sterile saline?
A: Artegraft is preserved in alcohol, thus the graft must be thoroughly rinsed with sterile saline and/or heparinized saline prior to implant. Read the Preparation For Implant guidelines attached to the package.
Q: If an Artegraft bottle is open and not used immediately, can it be used later?
A: No. Sterility will have been compromised.
Q: How should the preservative solution in the bottle be disposed?
A: Adhere to your hospital’s biohazardous waste protocol.