Does a small-diameter rod-type tunneler reduce postoperative swelling? An evaluation using a canine arteriovenous graft model

• Published in: Journal of artificial organs 2023-03, Vol.26 (1), p.65-72
• Main Authors: Maeda, Kazuha, Tsuneda, Ryo, Nishida, Hitoshi, Terao, Hisako, Hagiwara, Hitomi, Kazuno, Kimimasa
• Format: Article
• Language: English
• Subjects: Biomedical Engineering and Bioengineering; Cardiac Surgery; Complications; Damage prevention; Diameters; Dogs; Edema; Evaluation; Grafting; Implantation; Injury prevention; Medicine; Medicine & Public Health; Nephrology; Original Article; Sheaths; Swelling; Tissues
• ISSN: 1434-7229; 1619-0904
• DOI: 10.1007/s10047-022-01333-4

Purpose Sheath-type tunnelers are frequently used to create vascular access using vascular grafts. However, during vascular access creation, tunnelers damage the surrounding tissues, consequently causing problems, such as swelling, failure to heal, and infection. This study evaluated a novel rod-type tunneler that was designed to prevent tunneler-related tissue damage and its sequelae. Methods We developed a small-diameter rod-type tunneler that reduces injuries during subcutaneous tunnel creation. The rod diameter of this tunneler is smaller than the vascular graft diameter being implanted. It has a structure in which a vascular graft is implanted at a target site by grasping and pulling the vascular graft. Three dogs were used in the experiment, and arteriovenous grafts were created using a rod-type and a sheath-type tunneler on the left and right thighs, respectively, with a different type of commercially available graft used in each dog. The edema of the tissues surrounding the vascular graft was measured at 11 sites by ultrasonography at prespecified intervals. Results Compared with implantation using a sheath-type tunneler, when the self-sealing Rapidax II was implanted using the small-diameter rod-type tunneler, the postimplantation edema (degree of change) decreased by 28–53% and 80–247% in the peri-vascular-graft area and within the loop, respectively. The MAXIFLO and SEALPTFE did not significantly reduce postoperative edema but exhibited a tendency for improved postimplantation tissue healing. Conclusions The reduced-diameter rod-type tunneler may be a useful device for vascular graft implantation.