Using resorbable extracellular bio-matrix for construction and reconstruction of hemodialysis vascular access

We assessed the use of resorbable extracellular bio-matrix in vascular access surgery.

A retrospective analysis was made of procedures where a resorbable extracellular bio-matrix was used for the construction or reconstruction of an arteriovenous (AV) fistula. A tubular shape of a certain length and diameter was made from sheets of resorbable bio-matrix (CorMatrix), which was then incorporated into AV anastomosis. Puncturing for hemodialysis began 8 - 10 weeks after construction.

Since 2016, our unit has used resorbable extracellular bio-matrix in 22 patients. We used it as an arterial circuit to the AV fistula vein, a reduction segment in high-flow AV fistulas, to extend the puncture area, as a connecting segment after partial removal of an AV fistula, and to construct the entire AV fistula instead of a graft. All procedures were successful with no significant peri- or post-operative complications. Additional procedures to ensure patency were also successfully performed. Histopathological analysis showed complete vascular differentiation of the bio-matrix resulting in thickening of the wall and narrowing of the lumen.

The use of resorbable extracellular bio-matrix in vascular surgery is safe and feasible. It is recommended to use wider grafts to avoid thrombosis due to narrowing of the lumen. Further research and pre-prepared tubular bio-grafts of different diameters and lengths are needed.