Outcomes with arteriovenous fistulas in a pediatric population

Objective Kidney Disease Outcome Quality Initiative guidelines recommend permanent access in dialysis patients aged 0 to 19 years who weigh >20 kg and are unlikely to receive a transplant within 1 year. Unfortunately, >80% of these patients currently receive dialysis through a permanent cathet...

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Published in:Journal of vascular surgery 2014-07, Vol.60 (1), p.170-175
Main Authors: Wartman, Sarah M., MD, Rosen, David, MD, Woo, Karen, MD, Gradman, Wayne S., MD, Weaver, Fred A., MD, Rowe, Vincent, MD
Format: Article
Language:English
Subjects:
Adolescent
Age Factors
Arteriovenous Shunt, Surgical - adverse effects
Brachial Artery - surgery
Catheterization, Central Venous
Child
Child, Preschool
Female
Femoral Vein - surgery
Follow-Up Studies
Humans
Kidney Transplantation
Male
Radial Artery - surgery
Renal Dialysis
Renal Insufficiency, Chronic - therapy
Reoperation
Retrospective Studies
Subclavian Vein
Surgery
Thrombosis - etiology
Time Factors
Treatment Outcome
Vascular Patency
Young Adult
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Summary:Objective Kidney Disease Outcome Quality Initiative guidelines recommend permanent access in dialysis patients aged 0 to 19 years who weigh >20 kg and are unlikely to receive a transplant within 1 year. Unfortunately, >80% of these patients currently receive dialysis through a permanent catheter and are exposed to the associated risks and shortcomings. With a clear imperative to increase the incident use of permanent access in pediatric patients, our objective was to examine the long-term outcomes of pediatric arteriovenous fistulas (AVFs). Methods A retrospective review was performed of all AVFs created in a hemodialysis (HD) population aged 0 to 19 years at a single institution from 1999 to 2012. Data abstracted included age, weight, etiology of renal failure, time on dialysis, central venous catheter history, and transplantation history. Data were analyzed to determine the influence of these variables on primary and secondary patency. Results During the study period, 101 AVFs were performed in 93 patients, of whom 65 patients (70%) were male. Mean patient age was 14 years (range, 3-19 years), and mean weight was 51 kg (range, 12-131 kg). At the time of AVF creation, 66 patients (82%) were already receiving HD, with a mean length of HD dependence of 18 months. At the time of surgery, 78% of patients had a previous central venous catheter, and 24% had two or more catheters. Procedures performed included 43 radiocephalic fistulas, 29 brachiocephalic fistulas, 20 basilic vein transpositions, and 9 femoral vein transpositions. Mean follow-up was 2.5 years. The 2-year and 4-year primary and secondary patency rates were 83% and 92%, and 65% and 83%, respectively. Increasing age was correlated with improved primary patency ( P  = .02) but had no effect on secondary patency. Weight, etiology, catheter location, and catheter history were not significantly associated with primary or secondary patency. During the postoperative period, 68 patients (75%) received a renal transplant, with a mean time to transplant of 556 days. Conclusions AVFs demonstrate excellent long-term patency with minimal complications in pediatric HD patients, regardless of weight. Concerted efforts should be made to improve the incident use of AVFs in all pediatric patients with end-stage renal disease.
ISSN:0741-5214
1097-6809
DOI:10.1016/j.jvs.2014.01.050