Sheth Rita D, Brandt Mary L, Brewer Eileen D, Nuchtern Jed G, Kale Arundhati S, Goldstein Stuart L
Department of Pediatrics, and Michael E. DeBakey Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas 77030, USA.
Kidney Int. 2002 Nov;62(5):1864-9. doi: 10.1046/j.1523-1755.2002.00630.x.
Transplantation is the optimal therapy for pediatric end-stage renal disease (ESRD) patients, but in a subset of patients with peritoneal membrane failure, failed transplants or poor social situations, chronic hemodialysis (HD) remains the only option. Long-term survival of arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) in pediatric patients has not been well described.
We studied the survival of permanent vascular access in 34 pediatric ESRD patients treated with chronic HD at our institution between 1/1/89 and 12/1/95 and followed to 12/31/2000.
Twenty-four AVFs and 28 AVGs were created in 19 and 23 patients, respectively. Mean age and weight at insertion were 15.1 years (range 7.1 to 20.9) and 46 kg (18 to 81) for AVFs and 13.3 years (3.8 to 21.1) and 41.5 kg (10.5 to 145) for AVGs. Fifteen patients weighed <35 kg at the time of access creation (7 AVFs in 5 patients, 14 AVGs in 13 patients). Excluding primary failures, one-year, three-year and five-year patency rates for AVFs (74%, 59%, 59%) and AVGs (96%, 69%, 40%) were not significantly different. Patency did not correlate with patient weight or age at access creation. Primary access failure occurred more often (P < 0.01) in AVFs (8/24) compared to AVGs (1/28). Access thrombosis, stenosis and infection occurred more frequently in AVG (P = 0.02).
Both AVF and AVG function well even in small pediatric patients and have survival rates equivalent to adult series and longer than cuffed venous catheters in pediatric patients. Both AVFs and AVGs are preferable for long-term HD access in pediatrics.
移植是小儿终末期肾病（ESRD）患者的最佳治疗方法，但对于一部分腹膜功能衰竭、移植失败或社会情况不佳的患者，长期血液透析（HD）仍是唯一选择。小儿患者动静脉内瘘（AVF）和动静脉移植物（AVG）的长期存活情况尚未得到充分描述。
我们研究了1989年1月1日至1995年12月1日期间在我院接受慢性HD治疗并随访至2000年12月31日的34例小儿ESRD患者永久性血管通路的存活情况。
分别在19例和23例患者中创建了24个AVF和28个AVG。AVF植入时的平均年龄和体重分别为15.1岁（范围7.1至20.9岁）和46千克（18至81千克），AVG植入时的平均年龄和体重分别为13.3岁（3.8至21.1岁）和41.5千克（10.5至145千克）。15例患者在建立血管通路时体重<35千克（5例患者中有7个AVF，13例患者中有14个AVG）。排除原发性失败情况，AVF（74%、59%、59%）和AVG（96%、69%、40%）的一年、三年和五年通畅率无显著差异。通畅率与建立血管通路时患者的体重或年龄无关。与AVG（1/28）相比，AVF（8/24）发生原发性通路失败的情况更常见（P<0.01）。AVG中通路血栓形成、狭窄和感染的发生率更高（P=0.02）。
即使在小儿患者中，AVF和AVG的功能也良好，其存活率与成人系列相当，且比小儿患者的带 cuff 静脉导管更长。AVF和AVG均更适合小儿长期HD通路。
