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Limb growth and cardiac complications of fistulas in children
P C Guzzetta1, J R Salcedo, S B Bell
1Department of Surgery, Children's Hospital National Medical Center, Washington, D.C.
Insights
Arteriovenous (AV) fistulas in children for hemodialysis can cause complications. Long-term assessment revealed issues like limb hypertrophy and excessive flow, with 23% requiring ligation.
Area of Science:
- Pediatric Nephrology
- Vascular Surgery
Background:
- Vascular access is crucial for pediatric hemodialysis.
- Arteriovenous (AV) fistulas are a common form of access.
- Long-term effects in pediatric patients require thorough evaluation.
Purpose of the Study:
- To evaluate the long-term effects of AV fistulas in children.
- Assessed outcomes include limb growth, fistula flow, function, and aesthetics.
- Determined the complication rate and need for intervention.
Main Methods:
- Retrospective study of 26 pediatric patients (ages 4-20).
- Fistulas created an average of 31 months prior.
- Evaluated wrist fistulas and polytetrafluoroethylene (PTFE) grafts (thigh and upper arm).
Main Results:
- Thigh PTFE grafts were associated with limb hypertrophy (3/5) and cardiac failure (1/5).
- Upper arm PTFE grafts led to edema (1/7).
- Wrist fistulas showed excessive flow (2/14); 23% of all patients required fistula ligation due to complications.
Conclusions:
- AV fistulas in children can lead to significant long-term complications.
- PTFE grafts, particularly in the thigh, pose higher risks.
- Careful monitoring and consideration of alternative access methods are warranted.
Abstract:
To assess the long term effects of arteriovenous (AV) fistulas placed in children for hemodialysis, we retrospectively evaluated 26 patients, ages 4 to 20 years, for: limb growth, evidence of excessive flow through the fistula, limb function and patient acceptance of the limb's appearance. The fistulas were created an average of 31 months prior to the study. Fourteen patients had wrist fistulas. Twelve patients had PTFE grafts; 5 in the upper thigh and 7 in the upper arm. Of the 5 patients with thigh PTFE fistulas, 3 developed ipsilateral limb hypertrophy, another developed cardiac failure and the other had excessive flow through the fistula without cardiac failure. One of the 7 children with an upper arm PTFE graft developed arm edema without hypertrophy. Two of the 14 children with wrist fistulas developed evidence of excessive flow through the fistula. Six of 26 patients (23%) required fistula ligation because of a complication.