Long-Term Experience of Arterio-Venous Fistula Surgery in Children on Hemodialysis

Area of Science:

• Nephrology
• Pediatric Surgery
• Vascular Access

Background:

• Arterio-venous fistulas (AVFs) are the preferred initial vascular access for hemodialysis (HD) in pediatric patients.
• Assessing the outcomes and patency of AVFs in children is crucial for optimizing treatment strategies.

Purpose of the Study:

• To evaluate the single-center experience with AVF creation in pediatric patients.
• To determine the primary, primary-assisted, and secondary patency rates of AVFs in children.
• To identify factors influencing AVF patency in the pediatric population.

Main Methods:

• A retrospective analysis of pediatric patients (≤18 years) who underwent AVF creation between 1993 and 2023.
• Data collection included patient demographics, HD history, intraoperative details, and reintervention requirements.
• Patency rates (primary, primary-assisted, secondary) were calculated and analyzed.

Main Results:

• Fifty-seven pediatric patients with a median age of 15 years were analyzed.
• The primary failure rate was 10.5%, with 1-year primary patency at 67.6%.
• Excellent long-term patency was observed: 5-year secondary patency was 76.8%.

Conclusions:

• AVFs demonstrate an acceptable primary failure rate and superior long-term patency in pediatric patients.
• AVFs are a safe and effective vascular access option for children undergoing hemodialysis.
• The findings support the continued use of AVFs as a first-line access in pediatric HD.