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Safety and Feasibility of Endovascular Management of Pediatric Dialysis Access
Jake DiFatta1, Chase Mahler1, Junjian Huang2
1School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Insights
Pharmacomechanical intervention is safe and effective for maintaining pediatric dialysis access, with high technical success and no major complications. While patency rates are lower than in adults, these endovascular techniques offer a viable solution for young patients.
Area of Science:
- Pediatric Nephrology
- Interventional Radiology
- Vascular Access
Background:
- Maintaining functional dialysis access, including fistulas and grafts, is crucial for pediatric patients requiring hemodialysis.
- Pharmacomechanical interventions offer a minimally invasive approach to address access dysfunction.
Purpose of the Study:
- To evaluate the safety and efficacy of pharmacomechanical interventions for the maintenance of pediatric dialysis access in the extremities.
- To assess complication rates and technical success of these procedures in a pediatric population.
Main Methods:
- Retrospective analysis of 67 interventions in 17 pediatric patients undergoing dialysis access maintenance.
- Recorded use of angioplasty, stenting, thrombectomy, and thrombolytic agents (e.g., tissue plasminogen activator).
- Assessed safety per CIRSE guidelines; defined technical success as restored patency without significant stenosis.
Main Results:
- High technical success rate of 98.5% (66/67 interventions).
- Favorable safety profile with no major complications observed.
- Median time to reintervention was 107 days for patients requiring multiple treatments. Primary assisted and secondary patency at 6 months was 41.8%.
Conclusions:
- Endovascular techniques, including angioplasty, stenting, and thrombolysis, are safe and effective for pediatric dialysis access maintenance.
- While patency rates may be lower than in adults, these interventions provide a valuable treatment option for pediatric patients.
- The study supports the use of pharmacomechanical interventions in managing pediatric dialysis access complications.
Purpose:
To investigate the safety and efficacy of pharmacomechanical intervention in the maintenance of pediatric dialysis access fistulas and grafts in the extremities.
Materials And Methods:
A retrospective analysis of 67 interventions performed on 17 pediatric patients with dialysis access maintenance interventions was conducted. Use of angioplasty, stenting, thrombectomy devices, and thrombolytic agents such as tissue plasminogen activator (tPA) were recorded across interventions. Total number of interventions per patient and time between reinterventions were measured. Safety of these techniques was assessed according to the Cardiovascular and Interventional Radiology Society of Europe (CIRSE) complication guidelines. Technical success was defined as restoration of patency without a hemodynamically significant stenosis, and clinical success was defined as symptom resolution without reintervention of greater than 6 months.
Results:
The application of pharmacomechanical intervention demonstrated a favorable safety profile and high technical success rates across all categories. The median age at first intervention was 13 years (IQR 10.1-16.9, range 7-18), and median number of interventions was 2 with a range of 1-11. No major complications were observed during or after the procedures. Among the 67 interventions, angioplasty was the most frequently employed technique (n = 67, 100%), followed by thrombolysis and/or anticoagulation (n = 34, 50.7%), thrombectomy (n = 21, 31.3%), and stenting (n = 10, 14.9%). Technical success was 98.5% (66/67), and combined 6-month primary assisted and secondary patency from the index dialysis circuit intervention was 41.8% (28/67). For patients who received more than one treatment, median time to reintervention was 107 days.
Conclusion:
The high rate of technical success and absence of major or minor complications suggest that endovascular techniques for dialysis access maintenance including angioplasty, stenting, thrombolysis, and advances therapies can be safely and effectively performed in pediatric patients. Rates of primary and secondary patency are slightly lower compared to the adult population.
Level Of Evidence:
Level 4, Retrospective Cohort Study.
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