Long-term Patency of Arteriovenous Fistulas as a Vascular Access in Paediatric Age Group Patients with End-stage Renal Disease-Egyptian experience

Abstract

Background: Vascular access (VA) for hemodialysis (HD) is the cornerstone of treatment of end-stage renal disease in children. Purpose:To evaluate the causes that may result in primary failures, to evaluate the long-term outcome of AVFs in the vascular access as regards primary and secondary access patency, and to study the effect of patients' demographics and type of VA upon patency.Patients and methods: Paediatric age group patients with ESRD from El Shatby University Hospital for Children were evaluated by duplex ultrasound and VA was constructed.Results: 218 children were evaluated.188 children had AVF. The initial success rate was 96.8%. Early failure occurred in 13.9%. The mean follow-up was 18.9 ± 11.2 months. 75% of our patients were blow 50th percentile. The mean maturation-time was 1.7±0.5 months. Primary and secondary patency rates at 1, 2, and 3 years of follow-up, were 80.1% (± 2%), 67.3% (±2%), 41.3% (±2%), and 85.4% (±1%), 75.6% (± 1%), and 67.4% (± 1%) respectively. Complications were stenosis, thrombosis, infection, venous hypertension, steal, aneurysms and pseudoaneurysm, and high-flow AVF. At the end of the follow-up period, 32 (17.3%) AVFs were complicated and eventually failed, 20 (10.8%) were abandoned due to death or patients lost follow-up, and 125 (67%) were patent. Conclusion:AVFs in paediatric age group have a good outcome and long-term patency provided by good choice of the patient, and operation by dedicated surgeons. Surveillance of the fistula and rapid correction of any complications are very crucial steps to keep the fistula functioning.