Hemodialysis vascular access in children – A retrospective study in a pediatric dialysis unit
Authors:   Angiology and Vascular Surgery Department, Hospital Santo António – Centro Hospitalar Universitário do Porto, Porto – Portugal, Teixeira Gabriela ,   Grupo de Estudos Vasculares, GEV, Porto – Portugal, Almeida Paulo ,   Angiology and Vascular Surgery Department, Hospital Santo António – Centro Hospitalar Universitário do Porto, Porto – Portugal,   Grupo de Estudos Vasculares, GEV, Porto – Portugal, Matos Norton ,   Angiology and Vascular Surgery Department, Hospital Santo António – Centro Hospitalar Universitário do Porto, Porto – Portugal,   Grupo de Estudos Vasculares, GEV, Porto – Portugal, Faria Maria ,   Pediatric Department, Nephrology Unit, Centro Materno-Infantil do Norte - Centro Hospitalar Universitário do Porto, Porto – Portugal,   Research Unit on Applied Molecular Biosciences, UCIBIO\REQUIMTE, Gama Madalena ,   Pediatric Department, Nephrology Unit, Centro Materno-Infantil do Norte - Centro Hospitalar Universitário do Porto, Porto – Portugal, Loureiro Luís ,   Angiology and Vascular Surgery Department, Hospital Santo António – Centro Hospitalar Universitário do Porto, Porto – Portugal,   Grupo de Estudos Vasculares, GEV, Porto – Portugal, Rego Duarte ,   Angiology and Vascular Surgery Department, Hospital Santo António – Centro Hospitalar Universitário do Porto, Porto – Portugal,   Grupo de Estudos Vasculares, GEV, Porto – Portugal, Antunes Inês ,   Angiology and Vascular Surgery Department, Hospital Santo António – Centro Hospitalar Universitário do Porto, Porto – Portugal,   Grupo de Estudos Vasculares, GEV, Porto – Portugal, Silva Fernanda ,   Nephrology Department, Hospital Santo António – Centro Hospitalar Universitário do Porto, Porto – Portugal, Queirós José ,   Nephrology Department, Hospital Santo António – Centro Hospitalar Universitário do Porto, Porto – Portugal, Almeida Rui ,   Angiology and Vascular Surgery Department, Hospital Santo António – Centro Hospitalar Universitário do Porto, Porto – Portugal
Published: October 2021

Objective: Permanent access in the form of a fistula is the preferred form of vascular access for most pediatric patients on maintenance hemodialysis (HD) therapy; however, the technical aspects of the procedure that are unique to the pediatric population, the expectation of a short waiting time for kidney transplantation and the need to cannulate every other day (with the pain and fear associated with it) limit its use. Our objective was to analyze the long-term outcomes of pediatric arteriovenous fistulas in our institution. Methods: A retrospective review was performed of all arteriovenous fistula (AVF) created in a HD population aged 0 to 18 years at a single institution from 2007 to 2019. 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 primary and secondary patency. Results: During the study period, 19 AVFs were performed in 16 patients, of whom 9 patients (56.3%) were male. Mean patient age was 12.3 years (range 5-17 years), and mean weight was 38.3kg (range 12-83kg). At the time of AVF creation, 9 patients were on dialysis and 7 patients had a central venous catheter (CVC), with a median length of CVC dependence of 10 months. Procedures performed included 4 radiocephalic fistulas, 11 brachiocephalic fistulas and 4 brachiobasilic. Five accesses failed to mature (26.3%). Mean follow-up was 6 years. The 2-year primary and secondary patency rates were 92.3% and 100%, respectively. The 4-year primary and secondary patency rates were 76.9% and 100%, respectively. No thrombosis was documented during follow-up. During the postoperative period, 10 patients (62.5%) received a kidney transplant, in a mean time of 23 months. Conclusions: AVFs demonstrate excellent long-term patency in pediatric HD patients. No significant complications were reported and no thrombosis occurred.