Arteriovenous fistula for chronic hemodialysis in children

Each year, three to five children per million develop chronic renal failure. Of these one to two will require long-term hemodialysis support. From July 1992 to July 2000, we performed 19 surgical procedures to provide chronic hemodialysis access for a group of 14 children. There were 8 boys and 6 girls, with a mean age of 7.9 years (range 2.5-13). Ten of the children were between 2.5 and 10 years old. The mean weight of the children was 20.3 kg (range 12-49). Four children were only 12 kg in weight. The mean follow-up period was 42.1 months (range 10-96). Surgical technique was varied. Polytetrafluoroethylene (PTFE) grafts were used in 5 cases. The overall mean functional primary patency of the fistula was 30.2 months and secondary patency 31.6 months. Primary and secondary patency were better with autologous (39 and 40.6 months) than with PTFE graft (3.75 and 4.75 months). Providing dialysis access in the pediatric population is a time-consuming and frustrating challenge. We advocate the use of autologous material whenever possible. In children less than 12 kg in weight, brachiobasilic fistula is our first choice for angioaccess.