ESPN 50th Annual Meeting

ESPN 2017


 
Autologous Arteriovenous Fistulas using microsurgery techniques in children weighting ≤20 kg: A single center study
VASILIKI KARAVA 1 PASCAL JEHANNO 2 THERESA KWON 1 GEORGES DESCHENES 1 MARIE-ALICE MACHER 1 PIERRE BOURQUELOT 3

1- Nephrology Department, Hôpital Robert-Debré, APHP, Paris, France
2- Orthopaedic Surgery Department, Hôpital Robert Debré, APHP, Paris, France
3- Clinique Jouvenet, Paris
 
Introduction:

This study aims to describe a single-center experience regarding the efficiency and longevity of arteriovenous fistulas (AVF) created in children weighting ≤ 20 kg for haemodialysis (HD).

Material and methods:

We collected data of AVF created using microsurgery techniques between 1988 and 2015. Early failure was defined as the inability to use the AVF even once. Primary patency was defined as the interval time from VA placement until any intervention designed to maintain or reestablish patency and secondary patency as the interval time from VA placement until VA failure.

Results:

48 AVF (35 distal, 13 proximal) were created in 41 children with a median weight of 13.5 kg (range 5.5 to 20). Small age and body weight at AVF creation were associated to the need for a second AVF (p=0.046 and p=0.019 respectively). Early failure was observed in 6 (12.5%) AVF due to 4 access thromboses and 2 no-maturations. Median time to first utilization in HD was 22 weeks. Cumulative primary patency rates (± standard error) at 1 and 2 years were 54.2% (± 7.2) and 39.6% (± 7.1) respectively. Secondary patency rates (± standard error) at 1, 2, 3, 4 and 5 years were 85.4% (± 5.1), 83.3% (± 5.4), 70.5% (± 6.6) and 64.1% (± 7) and 57.7% (± 7.2) respectively. The average number of interventions performed per initially functional AVF was 1.36 (range 0-5). One third of thrombosis after AVF utilization were observed at kidney transplantation peri-operative time.

 

 

Conclusions:

Arteriovenous Fistulas are feasible in younger children with an early failure rate of 12.5%. Time to first utilization is longer than in older children but secondary patency is excellent. Thrombosis rate is considerably high during transplantation surgery.