Dehydrated Human Amnion Chorion Membrane (dHACM)* Allograft Utilization in the Revision and Closure of an Infected Ruptured Arteriovenous (AV) Fistula

We present our experience using dehydrated human amnion/chorion membrane (dHACM) allograft as a novel adjunct therapy integrated into the treatment plan and restoration of a failed arteriovenous fistula (AVF).

The patient is a 52-year-old male, living in United Arab Emirates (UAE), with multiple comorbidities including end-stage renal disease (ESRD) for which he received a renal allograft transplant in 1997. The transplant began to demonstrate signs of gradual failure in 2007.  In 2014, the patient had a right brachiocephalic AVF placed. In 2019, the patient presented with a ruptured aneurysmal AVF. An aneurysmoraphy was performed preserving function of the fistula. At 17 days post-aneurysmoraphy, an episode of active bleeding after dialysis occurred. A synthetic cardiovascular patch was placed to baffle the anterior wall of the right cephalic vein extending near the communication with the brachial artery maintaining the fistula patency on either side. A 2.5cm x 3.5cm skin defect resulted, thus a 4 x 4cm2 dHACM allograft was applied partly to the deep part of the wound with evaginated edges of the allograft to the exterior sides of the edges of the wound.  Following the surgical repair, the patient was monitored and he received hemodialysis through a temporary right femoral catheter.

Complete closure of the surgical wound was noted at 23 days post-surgery. Ten days after complete closure, a total of 36 days post-operatively from revision using the synthetic cardiovascular patch and dHACM barrier application, the temporary femoral catheter began to malfunction. At that time, the revised AVF was cannulated without any event.

The patient achieved a favorable outcome with preservation of his AVF given that he had few other vascular access options. Also notable was that the revised AVF was mature enough to be cannulated for hemodialysis 36 days post-revision.

Trademarked Items (if applicable): dHACM=EpiFix

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