Using CorMatrix for partial and complete (re)construction of arteriovenous fistulas in haemodialysis patients: (Re)construction of arteriovenous fistulas with CorMatrix

Abstract

Introduction: CorMatrix is an acellular extracellular matrix that acts as a biological scaffold and remodels into site-specific tissue. We used it for the (re)construction of arteriovenous fistulas. Methods: In this prospective pilot case study, we used CorMatrix in six patients. We included patients who required vascular access reconstruction due to thrombosis of unsalvageable arteriovenous fistulas, patients with high-flow arteriovenous fistulas and patients with microvasculature in which autologous arteriovenous fistulas did not mature, requiring reconstruction with a graft. We sutured the CorMatrix plate into a tubular shape and then constructed arterial and venous anastomoses. Results: There were no periprocedural complications, CorMatrix-related infections, bleeding or limb swelling after the procedures. CorMatrix was first punctured after 8–10 weeks. In five patients, a percutaneous angioplasty due to CorMatrix stenosis was performed; in one patient, a stent was placed due to refractory stenosis. We observed eight thromboses during the observation period (four in one patient). Perianastomotic stenosis of CorMatrix and interdialytic hypotension were the causes of the thrombosis in five patients, cephalic arch stenosis in two patients and thromboembolism to the brachial artery and arteriovenous fistula in one patient. Thrombendarteriectomy was successful in 87.5% of patients, and one patient required arteriovenous fistula reconstruction. After a median observation period of 12.5 (range 4–23) months, all arteriovenous fistulas were patent, with a median brachial artery flow of 1450 (range 700–1700) mL/min. Conclusion: Arteriovenous fistula (re)construction with CorMatrix seems to be feasible and safe, with a relatively high incidence of neointimal hyperplasia, predominantly at venous anastomoses, but additional clinical studies are needed.

Efficacy and Safety of Ureteral Catheter Use During Arteriovenous Fistula in End-Stage Renal Disease Patients with Poor Vascular Status

“…The blood flow in the internal fistula can be increased by exploring the venous valve on the venous circuit in an injured vein [17]. It is important that the operation is atraumatic and avoids forcible passage when entering the catheter so as not to damage the vascular endothelium.…”

Extracellular Matrix Patches for Endarterectomy Repair

“…The decellularized ECM of non-chemically crosslinked biomaterials acts both as a scaffold and a stimulus for the ingrowth of new vascular tissue (17). These characteristics have led to the successful use of such biomaterials, including SIS-ECM, in a wide range of cardiovascular procedures, from repairs of congenital heart and vascular defects to vascular reconstructions following trauma, hemodialysis (arteriovenous fistulas), and surgical interventions (31)(32)(33)(34)(35)(36)(37)(38).…”

The prognostic role of finger pressures and access flows in hemodialysis patients

“…5,10,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31, 32,33,34,35,36,37,38,39,40,41,42,43,44, 45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,7 8,79,80,81 patients. 40,44,47,62,65 One article added data to a second included article without adding new patients. 15,16 Diabetes mellitus (DM) was observed in 27% of patients and more commonly present in studies including HAIDI patients (60%) compared with studies in which HAIDI was absent (17%).…”

“…table 3). 47,54,55,56,57,58,59,60,61,62 Q a -drop was 1.7 L/min (2.8 to 1.1 L/min). Complications were reported in 13 patients (12%), mostly thrombosis (n=9).…”

“…Seven articles reporting on graft interposition were included (n=46 patients, 64% male, mean age 60 ; table 4). 44,62,65,69,70,71,72 Q a -drop was 1.6 L/min (2.9 to 1.3 L/min). Complications were reported in 7 patients (15%), mostly thrombosis (n=6).…”