Conversion of Teflon-Silastic shunts to A-V fistulas in small children with chronic renal failure

Abstract

Access to blood is still the most important determinant for continued wellbeing of patients with end-stage renal failure, maintained on haemodialysis (HD)1–3. The two types of vascular access used most frequently are the internal arteriovenous fistula as introduced by Brescia-Cimino and the external Teflon-Silastic shunt of Quinton-Scribner4,5. For chronic HD treatment the internal fistula represents the vascular access of choice, whereas in acute renal failure HD is started via a Scribner shunt in many centres2,6. In paediatric nephrology an immediate start of HD often becomes necessary because of acute onset of renal failure with rapid and - unfortunately often irreversible - deterioration of renal function. In this situation the A-V fistula is unsuitable since, particularly in children, many weeks or months may pass before an accessible vessel has matured. Therefore in these cases a Scribner shunt is used most commonly, later being abandoned in favour of a Cimino fistula on the contralateral forearm6. By this procedure, valuable vascular access sites are already wasted in the first weeks of dialysis treatment.