Utility of a tubularized extracellular matrix as an alternative conduit for arteriovenous fistula aneurysm repair.
OBJECTIVE
The treatment of segmental arteriovenous fistula aneurysms (AVFAs) remains a challenge in dialysis access preservation. We examined our experience with the use of tubularized extracellular matrix (ECM; CorMatrix, Roswell, Ga) for AVFA repair.


METHODS
Between October 2013 and January 2015, we conducted a prospective study of CorMatrix ECM for AVFA repair. All patients underwent intraoperative fistulography. Patients with central venous stenosis or occlusion had simultaneous angioplasty and stenting as indicated. The aneurysm and overlying skin were then resected, and an ECM patch was fashioned into a tube for interposition repair. Patients with multiple AVFAs underwent staged repair. Cannulation of the repaired segments was allowed after 6 weeks.


RESULTS
During the study period, 15 patients (40% male; mean age, 49.5 years) underwent 18 AVFA repairs using ECM (3 staged repairs). Six patients (40%) underwent simultaneous treatment of central vein lesions, whereas eight patients (53%) had associated skin erosion. Treated sites included radiocephalic (2), brachiobasilic (1), and brachiocephalic (15) AVFAs. All patients had hemodialysis at an alternative location on the same extremity without the need for catheter placement. Five patients underwent a follow-up ultrasound examination at a mean of 6 weeks. All studies demonstrated patency of the ECM segments without stenosis. At a mean follow-up time of 6.9 months, two thrombosis events were observed, both in patients with known refractory central venous stenosis treated with previous angioplasty (2) and stenting (1). Both patients required new access placement. No complications were attributable to ECM sites.


CONCLUSIONS
ECM is an alternative conduit for salvage of an autologous AVFA. This technique may help avoid the use of prosthetic grafts and hemodialysis catheters. Patients with associated central venous stenosis are at risk of thrombosis.
Department of Cardiothoracic and Vascular Surgery, The University of Texas Medical School at Houston and the Memorial Hermann Heart & Vascular Institute, Houston, Tex.
Joseph J
JJ
DuBose
Department of Cardiothoracic and Vascular Surgery, The University of Texas Medical School at Houston and the Memorial Hermann Heart & Vascular Institute, Houston, Tex.
Gerald R
GR
Fortuna
Department of Cardiothoracic and Vascular Surgery, The University of Texas Medical School at Houston and the Memorial Hermann Heart & Vascular Institute, Houston, Tex.
Kristofer M
KM
Charlton-Ouw
Department of Cardiothoracic and Vascular Surgery, The University of Texas Medical School at Houston and the Memorial Hermann Heart & Vascular Institute, Houston, Tex.
Naveed
N
Saqib
Department of Cardiothoracic and Vascular Surgery, The University of Texas Medical School at Houston and the Memorial Hermann Heart & Vascular Institute, Houston, Tex.
Charles C
CC
Miller
Department of Cardiothoracic and Vascular Surgery, The University of Texas Medical School at Houston and the Memorial Hermann Heart & Vascular Institute, Houston, Tex.
Anthony L
AL
Estrera
Department of Cardiothoracic and Vascular Surgery, The University of Texas Medical School at Houston and the Memorial Hermann Heart & Vascular Institute, Houston, Tex.
Hazim J
HJ
Safi
Department of Cardiothoracic and Vascular Surgery, The University of Texas Medical School at Houston and the Memorial Hermann Heart & Vascular Institute, Houston, Tex. Electronic address: ali.azizzadeh@uth.tmc.edu.
Ali
A
Azizzadeh
D000328:Adult; D000368:Aged; D000783:Aneurysm / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001705:Bioprosthesis; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D005109:Extracellular Matrix / Q000637:transplantation*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011474:Prosthesis Design; D006435:Renal Dialysis; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*; D014654:Vascular Patency