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[Arteriovenous fistula for pediatric hemodialysis. Experience of 9 years]

A López Uriarte, S Ledón Valenzuela, C López Gámez

    Boletin Medico Del Hospital Infantil De Mexico
    |July 1, 1978
    PubMed

    Insights

    This study evaluated 78 arteriovenous (A-V) fistulas in children for chronic hemodialysis. Saphenous vein autografts and bovine carotid artery grafts showed promise, while external shunts had higher complication rates.

    Area of Science:

    • Vascular Surgery
    • Pediatric Nephrology
    • Dialysis Access

    Context:

    • Chronic hemodialysis in children necessitates reliable vascular access.
    • Arteriovenous (A-V) fistulas are a common method for achieving this access.
    • Evaluating different A-V fistula types is crucial for optimizing pediatric dialysis outcomes.

    Purpose:

    • To assess the efficacy and complications of various A-V fistula constructions in pediatric patients undergoing chronic hemodialysis.
    • To compare the outcomes of external A-V shunts, saphenous vein autografts, latero-lateral arteriovenous anastomosis, saphenous-femoral anastomosis, and bovine carotid artery grafts.

    Summary:

    • Seventy-eight A-V fistulas were created in 45 children (ages 4-16) for chronic hemodialysis.
    • External A-V shunts (n=24) experienced high thrombosis (13) and removal (3) rates.
    • Saphenous vein autografts (n=36) had thrombosis (10) and dilation (5) complications.
    • Latero-lateral anastomosis (n=9) often resulted in poor blood flow.
    • Saphenous-femoral anastomosis (n=6) showed thrombosis (3) and difficult venous puncture.
    • Bovine carotid artery grafts (n=3) proved efficient for hemodialysis access.
    • No local or cardiovascular complications were observed.

    Impact:

    • Bovine carotid artery grafts and saphenous vein autografts appear to be viable options for pediatric hemodialysis access.
    • External shunts and certain direct anastomosis techniques present significant challenges.
    • Findings guide the selection of optimal surgical techniques for pediatric dialysis access, potentially improving patient outcomes.

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