Long‐term safety and feasibility of arteriovenous fistulae as vascular accesses in children with haemophilia: a prospective study

Abstract

Summary. Infectious and thrombotic complications limit the long-term use of subcutaneous ports as venous accesses for children with haemophilia. This study has evaluated for the first time the safety and feasibility of internal arteriovenous fistulae (AVF) as alternative accesses. During the 3-year study period, 27 severe haemophiliacs, 14 with factor VIII inhibitors (52%), underwent the creation of 31 proximal AVF in the forearm. Mild forearm haematomas were observed after five procedures (16%) in five patients who had or developed inhibitors after surgery. Inadequate AVF maturation was observed after five of 31 procedures (16%) in four children. AVF were first accessed after a median of 42 d and regularly used at home by 26 patients (96%) for a median follow-up period of 29 months. Thrombosis of a venous branch occurred in one AVF (3%) after 9 months of uncomplicated use in a child with inhibitor who spontaneously recovered from the symptoms and still used AVF for nine additional months. Mild symptoms, referable to distal ischaemia, were transiently reported by two children (7%) who needed no remedial intervention. This study demonstrates that the use of AVF in haemophiliacs enabled long-term treatment at home in all patients but one.

Improved treatment feasibility in children with hemophilia using arteriovenous fistulae: the results after seven years of follow-up

“…Since the '90s the use of CVADs in hemophiliac children has been implemented at our Center, 10 however due to the high rate of infectious complications, AVF was evaluated as a candidate option. 7 The first AVFs were created from 1999 in children who had their CVADs removed because of infection; the use of AVF was then gradually introduced as the first option in patients who needed a long-lasting venous access. For this reason CVADs were mainly used at our center until 1999 (only 5 implanted after 2000) and AVFs were preferred afterwards.…”

“…Surgical eligibility was evaluated by the same vascular surgeon (LB) and the most suitable vascular site and the configuration of AVF were decided according to age, vessel size and blood flow, 7 the non-dominant upper limb being preferred if possible. Caregivers were recommended not to access the chosen vessels until AVF creation.…”

“…7 Patients with highresponding inhibitors were treated with recombinant activated FVII (rFVIIa), administered by bolus injection or by continuous infusion (CI) for 5-6 days. …”

“…[3][4][5][6] Since 1999, AVF has been evaluated as a suitable alternative to CVADs in hemophilic children. Our preliminary experience 7 showed that AVF was well accepted by children and parents because it is easy to use in the home setting, does not limit the child's activities and is associated with a low rate of complications. 7 However, a prolonged follow-up was warranted to establish the safety of this approach.…”

“…Our preliminary experience 7 showed that AVF was well accepted by children and parents because it is easy to use in the home setting, does not limit the child's activities and is associated with a low rate of complications. 7 However, a prolonged follow-up was warranted to establish the safety of this approach. This study provides data on the long-term use of AVF in hemophilic children and evaluates the impact of this mode of venous access on the feasibility of treatment in children with or without factor VIII inhibitors.…”