Arteriovenous fistula as stable venous access in children with severe haemophilia

Area of Science:

• Pediatric Hematology
• Vascular Surgery
• Hemophilia Treatment

Background:

• Children with severe hemophilia require frequent infusions for prophylaxis and immune tolerance induction (ITI).
• Adequate venous access is crucial for effective hemophilia management, with peripheral veins preferred but central venous catheters (CVCs) often used.
• CVCs are associated with infectious and thrombotic complications, potentially disrupting treatment, especially ITI.

Purpose of the Study:

• To evaluate internal arteriovenous fistula (AVF) as a safer alternative venous access for children with severe hemophilia.
• To compare the complication rates and usability of AVF versus CVCs in pediatric hemophilia patients.

Main Methods:

• Review of existing literature and case reports on AVF use in pediatric hemophilia.
• Analysis of complication profiles, including infectious, thrombotic, and surgical issues associated with AVF.
• Assessment of AVF's suitability for home-based care and patient/parent acceptance.

Main Results:

• AVF demonstrates a lower rate of infectious complications compared to CVCs.
• AVF is user-friendly for home administration and generally well-accepted by children and parents.
• Potential AVF complications include postoperative hematoma, transient distal ischemia, and rare thrombosis; regular monitoring is essential.

Conclusions:

• Internal arteriovenous fistulas represent a promising alternative venous access for managing severe hemophilia in children.
• AVF facilitates consistent treatment delivery, particularly for immune tolerance induction, with improved safety and patient compliance.
• Surgical removal of AVF is advised once transition to peripheral venous access is feasible.