References
Use of dehydrated human amnion chorion membrane allograft on infected ruptured arteriovenous fistula: revision and closure
Abstract
Objective:
Over two million individuals worldwide, with end-stage renal disease (ESRD), depend on dialysis therapy or a kidney transplant for survival. Every haemodialysis patient requires vascular access. The arteriovenous fistula (AVF) is preferred for long-term hemodialysis vascular access due to long-term primary patency rates. Given the limited options for haemodialysis access and placement, preservation of existing AVF sites is always a clinical priority. This case report describes a novel approach to wound closure with the application of dehydrated amnion chorion human membrane (dHACM) at an AVF surgical site known to be complicated with issues of scarring and tissue breakdown. The patient was treated successfully with the imperative preservation of his AVF given that he had few other vascular access options.
Chronic kidney disease (CKD) is a growing worldwide crisis. According to the 2010 Global Burden of Disease study published in The Lancet, CKD was 27 in the list of causes of total number of deaths worldwide in 1990 but had climbed to 18 by 2010.1 Individuals with diabetes, peripheral artery disease (PAD), hypertension, heart failure, liver diseases and advanced age are among those at risk of CKD and end-stage renal disease (ESRD). Other iatrogenic risk factors include renal toxicity due to medications or other chemical exposure. Treatment of CKD depends on the severity of the disease and in stage 5 ESRD peritoneal dialysis, haemodialysis or kidney transplant is needed. It is estimated that over two million individuals worldwide are stricken with ESRD and depend on dialysis therapy or a kidney transplant for survival. However, this estimation may only represent 10% of the individuals who require these life-sustaining therapies.2 In the US alone, it is estimated that over 600,000 individuals with ESRD are haemodialysis-dependent.2
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