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Autologous arteriovenous fistulas for hemodialysis using microsurgery techniques in children weighing less than 20 kg

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Abstract

Background

This study aimed to describe the efficiency and longevity of arteriovenous fistula (AVF) for hemodialysis (HD) in children weighing ≤20 kg.

Methods

We collected data of all AVFs created using microsurgery techniques between 1988 and 2015. Success was considered as the ability to use the AVF for HD. Primary and secondary patency rates were measured.

Results

Forty-eight AVFs (35 forearm, 13 upper arm) were created in 41 children with a median weight of 13.5 kg (range 5.5–20). The need for a second AVF was significantly higher in younger and thinner children at the time of AVF creation (p = 0.046 and p = 0.019, respectively). Successful use for HD occurred in 42 AVFs (87.5%), while six (12.5%) resulted in failure for early thrombosis or nonmaturation. Median time to first cannulation was 18.8 weeks (range 2–166.3). Primary and secondary patency rates at 1, 5, and 10-year follow-ups were 54.2%, 29.2%, and 13.7%; and 85.4%, 57.7%, and 33%, respectively. Almost one third of thromboses after first AVF cannulation were observed at kidney transplantation (KT) perioperatively. At the end of the follow-up (median duration 5.07 years, range 0–17.95), one patient was still on HD via AVF, two died of unrelated reason, and 38 were transplanted—one of whom returned to HD with a new AVF.

Conclusions

AVF using microsurgery techniques is feasible in young children, showing an early failure rate of 12.5%. Time to first cannulation may be rather long, but secondary patency is excellent. Thrombosis rate is high during KT.

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Abbreviations

AVF:

Arteriovenous fistula

CAKUT:

Congenital abnormalities of kidney and urinary tract

CDI:

Color duplex imaging

CVC:

Central venous catheter

ESRD:

End-stage renal disease

HD:

Hemodialysis

KT:

Kidney transplantation

PD:

Peritoneal dialysis

RRT:

Renal replacement therapy

PTA:

Percutaneous transluminal angioplasty

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Acknowledgements

Special thanks from Pierre Bourquelot to Pr. Chantal Loirat for her constant support.

Author information

Authors and Affiliations

  1. Pediatric Nephrology Department, Robert Debré Hospital, APHP, 48 Boulevard Sérurier, 75019, Paris, France

    Vasiliki Karava, Theresa Kwon, Georges Deschênes & Marie-Alice Macher

  2. Pediatric Orthopaedic Surgery Department, Robert Debré Hospital, APHP, Paris, France

    Pascal Jehanno

  3. Angio-access Surgery Department, Clinique Jouvenet, Paris, France

    Pierre Bourquelot

Authors
  1. Vasiliki Karava
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  2. Pascal Jehanno
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  3. Theresa Kwon
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  4. Georges Deschênes
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  5. Marie-Alice Macher
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  6. Pierre Bourquelot
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Corresponding author

Correspondence to Vasiliki Karava.

Ethics declarations

This study was approved by the local ethics committee. Patient formal consent was not required.

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The authors declare that they have no conflict of interest.

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Karava, V., Jehanno, P., Kwon, T. et al. Autologous arteriovenous fistulas for hemodialysis using microsurgery techniques in children weighing less than 20 kg. Pediatr Nephrol 33, 855–862 (2018). https://doi.org/10.1007/s00467-017-3854-6

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  • DOI: https://doi.org/10.1007/s00467-017-3854-6

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