Autologous arteriovenous fistulae using microsurgery for hemodialysis in young children weighing 20 kg or less: Single center experience

Abstract

Introduction Arteriovenous autologous fistula (AVF) is the best vascular access (VA) for hemodialysis but its feasibility in smaller children remains a surgical challenge. This study aims to describe a single-center experience regarding the efficiency, longevity and associated morbidities of AVF created in children weighting ≤ 20 kg. Material and methods We collected data of all AVF created using microsurgery techniques after preoperative ultrasound vascular mapping between 1988 and 2011. Primary patency (PP) was defined as the interval time from VA creation until any intervention designed to maintain or re-establish patency or until VA abandonment (failure or transplantation). Secondary patency (SP) was defined as the interval time from creation to VA abandonment. Results Fifty AVF (36 distal, 14 proximal) were created in 40 children with a median weight of 13 kg (range 6 to 22). A total of 22 children were already on extra-renal epuration: 18 on HD via central venous catheter and 4 on peritoneal dialysis. Early complications during the first month after AVF creation were observed in 8 AVF, 6 thrombosis, which were abandoned, and 2 non maturations (1 re-operated successfully). Median time to maturation (first utilization in HD) was 4 months. Secondary complications observed between the first month after AVF creation and transplantation or VA failure were the following: 18 thrombosis (39% of which occurred during transplantation surgery), 22 stenosis (15 corrected by angioplasty, 4 by surgery whether 3 ended to AVF failure) and 3 high blood flow rate (1600, 1850, 2100 mL/min/1,73 m2) without evidence of cardiac complications. Median duration of PP and SP were 7 and 17 months respectively. Conclusions In our experience, AVF is feasible in younger children with 86% of success. Time to maturation is longer than in older children but SP after creation is excellent. Attention should be paid during transplantation surgery, as thrombosis rate is considerably high.