Experience with Autogenous Arteriovenous Access for Hemodialysis in Children and Adolescents
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,
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Vascular Access and Peritoneal Dialysis Catheter Placement in Children
2022, Handbook of Dialysis TherapyOutcomes of arteriovenous fistula for hemodialysis in pediatric age group
2021, Annals of Medicine and SurgeryCitation Excerpt :In the current report, one-year primary patency rate was 88% and two-year primary patency rate was 79.6%. When AVF was first attempted in children, a 50% immediate failure rate was reported [20]. Over the years, advances in AVF creation, especially with increased surgical experience, have shown primary failure rates as low as 5%.
Hemodialysis and peritoneal dialysis access related outcomes in the pediatric and adolescent population
2020, Journal of Pediatric SurgeryCitation Excerpt :Prior studies have reported primary patency rates that range from 43 to 100% and secondary patency in the range of 64–100% at 1 year [10,12,13,16,17,19,32]. These studies were largely limited by their relatively small sample sizes and nonuse of the standard reporting terms [16–18,33,34]. However, we acknowledge the efforts of the preceding investigators in evaluating this unique and often understudied category of patients.
Challenges of Vascular Access in the Pediatric Population
2020, Advances in Chronic Kidney DiseaseCitation Excerpt :The type and location of vascular access should be discussed between the pediatric nephrologist, vascular access surgeon, and interventionalist. Vein mapping using a duplex ultrasound scan can be utilized to plan the vascular access based on vein diameter and patency.42 In cases of patients with previous CVC cannulations, additional imaging should be performed to exclude central venous stenosis.
Vascular Access in Children
2017, Handbook of Dialysis Therapy: Fifth EditionOutcomes with arteriovenous fistulas in a pediatric population
2014, Journal of Vascular Surgery
Presented at the Twenty-second Annual Meeting of the Southern California Vascular Surgical Society, April 30-May 2, 2004.