Elsevier

Annals of Vascular Surgery

Volume 19, Issue 5, September 2005, Pages 609-612
Annals of Vascular Surgery

Experience with Autogenous Arteriovenous Access for Hemodialysis in Children and Adolescents

https://doi.org/10.1007/s10016-005-6829-1Get rights and content

The National Kidney Foundation's DOQI-NKF recommendation to construct an autogenous arteriovenous access (AAVA) for chronic hemodialysis whenever possible can be a challenge in the pediatric population. This report reviews recent surgical experience in this patient subgroup. From March 1999 to April 2004, 47 consecutive children requiring permanent vascular access had construction of AAVA. There were 16 girls and 31 boys, with a mean age of 14.6 years (range 5–20). The surgeon preoperatively mapped veins with ultrasound in all patients. Access sites were radial-cephalic (n = 16), upper arm brachial-cephalic (n = 15), transposed upper arm brachial-basilic (n = 7), and transposed femoral vein (n = 9). An operating microscope was used to construct three radial-cephalic accesses in individuals with small arteries. Three forearm cephalic veins were transposed (one at the original surgical procedure and two postoperatively). Five upper arm cephalic veins were transposed (three at the original surgical procedure and two postoperatively). Femoral vein accesses were constructed for either exhausted access in the upper extremities (n = 7) or patient preference (n = 2). Primary patency at 1 and 2 years was 100% and 96%, respectively. Secondary patency at 1 and 2 years was 100%. One individual with a radial-cephalic AAVA and severe radial artery calcification required an inflow procedure. Thirty-five accesses are currently in use (functionally patent), eight are in individuals with successful renal transplants, and two are maturing; one individual declines using the access. Two accesses are secondarily patent (thrombosed and repaired 12 and 29 months after construction, respectively), and one access thrombosed after 27 months (abandoned). Construction of an AAVA is possible in virtually all pediatric age individuals if attention is given to preoperative vein mapping, selective use of an operating microscope, and creation of a transposed femoral vein when upper extremity access is neither possible nor desired.

Section snippets

INTRODUCTION

The National Kidney Foundation's DOQI-NKF recommendation to construct an autogenous arteriovenous vein access (AAVA) in greater than 50% of patients can be a challenge in children less than 21 years old.1 Previous studies in this age range report wide variability in the successful construction of a durable autogenous vein access. This report reviews a single surgeon's recent experience in this patient subgroup.

PATIENTS AND METHODS

The charts of pediatric patients with end-stage renal disease (ESRD) who had construction of an arteriovenous access at Cedars-Sinai Medical Center between March 1, 1999, and April 15, 2004, were reviewed. Institutional review board approval was obtained. All patients had previous evaluation and/or treatment at the Children's Hospital Los Angeles Department of Nephrology, and most continued treatment at that facility after access construction. Age, gender, weight, ethnicity, original disease

RESULTS

Forty-seven consecutive patients (31 male, 16 female) requiring a permanent access for hemodialysis had construction of an AAVA. Thirty-five (74%) were Hispanic, five (11%) were African American, four (8%) were Asian, and three (6%) were Caucasian. The mean age at the time of surgery was 14.6 years (range 5–20). Forty-four of 47 patients were below mean weight for their age. The etiology of renal disease is enumerated in Table I.

Thirty-six patients had prior treatment of ESRD with one or more

DISCUSSION

About 7,000 children have ESRD in the United States today, and 1,300 new patients require treatment every year.4 Renal transplantation has excellent results in children and is the ideal goal of treatment.5, 6 The prevalence of transplantations in children is currently 67%; therefore, some children do require dialysis.4 Continuous ambulatory peritoneal dialysis (CAPD) is preferred over hemodialysis in North America and northern Europe.7, 8, 9 CAPD is simple to administer, needles are avoided,

REFERENCES (16)

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Presented at the Twenty-second Annual Meeting of the Southern California Vascular Surgical Society, April 30-May 2, 2004.

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