Abstract

Aim: AVFs may be considered as the best type of venous access for chronic hemodialysis in pediatric patients. Vascular access for chronic hemodialysis should meet the following criteria: long-term patency rate, low complication rate and manageable or minimum impact on desired daily activities.

The aim of the study was to report our experience in the creation of AVFs in pediatric candidates for using microsurgical vascular techniques, with emphasis on the details of the surgical technique.

Material and Method: We retrospectively evaluated AVFs created at our center between June 2011 and Februrary 2016. In 35 patients 40 fistulas were opened including 6 snuff-boxes, 21 radial-cephalic, 11 brachial-cephalic, one brachial-basilica and one femoro-femoral fistulas. Mean age of the patients was 12 (range 8 to14) years. AVFs were created using end to side anastomoses performed with 7/0 or 8/0 prolene sutures, and parachute technique.

Results: Four (75”%) snuff-box AVFs, 19 (90%) radialcephalic, 9 (81.1%) brachial-cephalic and all of (100 %) brachial-basilic and femoro-femoral AVFs were patent after the operation. After 37 months of follow-up success rate was %86.4.

Conclusion: Arteriovenous fistulas created in the pediatric patients had a similar success rate compared to the ones created in adult patients in the literature. Microsurgical vascular techniques used in our patients explain our success rates regarding AVFs.

First-line treatment for end-stage renal disease (ESRD) is peritoneal dialysis. However in patients who are not suitable for peritoneal dialysis, AVFs created using microsurgical techniques can be applied with success.