Related Experiment Video
Updated: Jun 19, 2026
Creating Radio-cephalic Arteriovenous Fistula in the Forearm with a Modified No-Touch Technique
Published on: April 1, 2022
A vascular access team can increase AV fistula creation in pediatric ESRD patients: a single center experience
Deepa H Chand1, Dale Bednarz, Matthew Eagleton
1Pediatric Nephrology and Hypertension, Akron Children's Hospital, Akron, Ohio 44308, USA. dchand@chmca.org
Insights
Pediatric hemodialysis (HD) patients often use central venous catheters. Arteriovenous fistula (AVF) creation, even in young children, shows high usage and patency rates, exceeding NKF-DOQI recommendations.
Area of Science:
- Nephrology
- Pediatric Surgery
- Vascular Access
Background:
- Central venous catheters are the most common, though suboptimal, vascular access for pediatric hemodialysis (HD).
- Optimizing vascular access techniques is crucial for children undergoing HD.
- National Kidney Foundation Dialysis Outcomes Quality Initiative (NKF-DOQI) recommends permanent vascular access.
Purpose of the Study:
- To report outcomes of arteriovenous fistula (AVF) creation in pediatric HD patients.
- To describe the experience and outcomes using an operating microscope for AVF creation in children under 15 kg and as young as 4 years.
- To demonstrate the applicability of Fistula First principles in pediatric HD.
Main Methods:
- Single-surgeon, single-center study of AVF creation in pediatric HD patients.
- Utilized operating microscope for AVF creation in very young and low-weight children.
- Followed Fistula First principles for vascular access management.
Main Results:
- Achieved high AVF usage rates in the pediatric population.
- Demonstrated favorable short- and long-term AVF patency rates with proper management.
- Exceeded the NKF-DOQI recommendation of 50% fistula use in prevalent HD patients.
Conclusions:
- Arteriovenous fistula creation is feasible and effective in pediatric HD patients, including very young and low-weight individuals.
- The operating microscope facilitates successful AVF creation in this challenging population.
- Fistula First principles can be successfully applied to pediatric hemodialysis, improving vascular access outcomes.
Abstract:
The National Kidney Foundation Dialysis Outcomes Quality Initiative (NKF-DOQI) recommends the use of a permanent vascular access for pediatric hemodialysis (HD) patients; however, central venous catheters are the most common vascular access used among children. In children receiving HD, central venous catheters, while suboptimal, are the most common vascular access used. As such, it is imperative that pediatric HD providers optimize vascular access techniques. We report outcomes of arteriovenous fistula (AVF) creation by a single surgeon in pediatric HD patients dialyzed at a single center. We further describe our experience and outcomes with the use of the operating microscope in the United States in children receiving HD under 15 kg in weight and as young as 4 years of age. AVF usage rates as well as short- and long-term patency rates can be quite high with proper management. We further illustrate that the Fistula First principles can be applied to the pediatric population in the setting of a single surgeon with single center experience. As such, we have surpassed the current NKF-DOQI recommendation of 50% fistula use in prevalent HD patients.
