Creating arteriovenous fistulas for children in Guatemala

Area of Science:

• Nephrology
• Pediatric Surgery
• Vascular Access

Background:

• Guatemala's first comprehensive pediatric nephrology program and hemodialysis unit were established in 2003.
• Pediatric vascular access (VA) expertise was limited, relying heavily on non-cuffed dialysis catheters.
• Bridge of Life (BOL) provided crucial support for establishing a hemodialysis unit and requested VA surgical assistance.

Purpose of the Study:

• To analyze the outcomes of BOL pediatric vascular access (VA) surgical missions to Guatemala.
• To establish a sustainable VA surgical program for pediatric patients with kidney disease.
• To create arteriovenous fistulas (AVFs) as a preferred form of permanent vascular access.

Main Methods:

• Three surgical missions were conducted between 2015 and 2017, involving teams of surgeons, local pediatric surgeons, nephrologists, and nurses.
• Supplies and equipment, including ultrasound units, were brought to Guatemala for each mission.
• A retrospective review of patient demographics, procedures, and outcomes was performed.

Main Results:

• Arteriovenous fistulas (AVFs) were created in 54 new pediatric patients (ages 8-19 years).
• Primary and cumulative patency rates were 83% and 85% at 12 months, and 62% and 85% at 36 months, respectively.
• No operative deaths or major complications occurred; four patients successfully underwent transplantation.

Conclusions:

• Pediatric VA missions successfully established safe and functional AVFs in Guatemalan children.
• Collaboration with local healthcare professionals fostered teaching and improved surgical capacity.
• The missions demonstrated the feasibility and effectiveness of creating AVFs for pediatric end-stage renal disease patients in resource-limited settings.