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Improved hemodialysis access in children
Insights
Expanded polytetrafluoroethylene (PTFE) grafts offer superior long-term vascular access for pediatric hemodialysis compared to bovine carotid heterografts. PTFE grafts demonstrate better patency and fewer complications, making them the preferred choice for children requiring chronic dialysis.
Area of Science:
- Pediatric Nephrology
- Vascular Surgery
- Biomaterials Science
Background:
- Vascular access for chronic hemodialysis in children presents significant challenges.
- Difficulties include vessel size, limited shunt lifespan, and repeated punctures for internal fistulae.
Purpose of the Study:
- To evaluate the efficacy and safety of expanded polytetrafluoroethylene (PTFE) grafts for long-term hemodialysis access in pediatric patients.
- To compare PTFE graft outcomes with bovine carotid heterograft (BCH) fistulae.
Main Methods:
- Twenty-five 6-mm PTFE grafts were inserted in 23 children (upper arm or thigh).
- Patient outcomes, including dialysis sessions, patency rates, and complication rates, were recorded.
- Comparison was made with 22 BCH fistulae from the preceding two years.
Main Results:
- PTFE grafts achieved 88% long-term patency with a 36% complication rate (mostly minor).
- Patients underwent 60 to 370 successful dialysis sessions per graft.
- BCH fistulae showed only 36% patency and a 69% complication rate (mostly major).
Conclusions:
- Expanded polytetrafluoroethylene (PTFE) grafts are a preferred method for long-term hemodialysis access in children.
- PTFE grafts offer significantly better patency and lower complication rates than bovine carotid heterografts.
Abstract:
Vascular access for chronic hemodialysis in children is difficult because of problems that include obtaining vessels of sufficient size, the limited life-span of external shunts, and the multiple painful punctures associated with internal fistulae. Twenty-five expanded polytetraflouroethylene (PTFE) grafts of 6-mm diameter were inserted for dialysis access over a 2-yr period in 23 children. Grafts were placed either in the upper arm or thigh. Each patient was successfully dialyzed from 60 to 370 times. Longterm patency of the PTFE grafts was 88%, with a complication rate of 36%, mostly minor. The same ease of insertion and high flow characteristics were noted in a series of 22 bovine carotid heterograft (BCH) fistulae inserted in the two years immediately preceeding this study. However, the patency rate was only 36% and the complication rate was 69%, mostly major. We consider the PTFE graft fistula to be the preferred method for long-term hemodialysis access in children.