Haricharan Ramanath N, Aprahamian Charles J, Morgan Traci L, Harmon Carroll M, Barnhart Douglas C
Division of Pediatric Surgery, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
J Pediatr Surg. 2008 Jan;43(1):147-51. doi: 10.1016/j.jpedsurg.2007.09.036.
The goal of this study was to estimate the 2-year cumulative thrombosis-free survival of basilic vein transposition (BVT) and brachiocephalic fistulae in children.
All children who underwent BVT or brachiocephalic fistula construction at a tertiary care children's hospital from June 2001 to July 2006 were reviewed. Kaplan-Meier analysis, log-rank test, and proportional hazards regression were done.
Sixteen children (7 girls) with inadequate forearm veins underwent creation of 18 fistulae (12 BVT, 6 brachiocephalic). Median age was 14 (9-19) years. Mean (+/-SE) operative times for BVT and brachiocephalic fistulae were 3.4 (+/- 0.6) hours and 1.9 (+/-0.4) hours, respectively. The overall 2-year cumulative survival rate was 74% (BVT, 66%; brachiocephalic fistula, 83%). Four fistulae failed (1 brachiocephalic, 3 BVT) and 14 fistulae were censored (5, patent fistula; 4, renal transplantation; 2, unrelated death; 1, elective conversion to peritoneal dialysis; 1, surgical ligation of fistula; 1, lost to follow-up). Of 18 fistulae, 6 underwent additional interventions (4, percutaneous angioplasty; 2, surgical thrombectomy). There were no significant differences in survival times based on fistula type, prior transplant status, age, or operative time.
Brachiocephalic and BVT fistulae create reliable hemodialysis access for children who have inadequate forearm veins to allow construction of more distal fistulae.
本研究的目的是评估儿童贵要静脉转位术（BVT）和头臂动静脉内瘘的2年无血栓累积生存率。
回顾了2001年6月至2006年7月在一家三级儿童专科医院接受BVT或头臂动静脉内瘘构建的所有儿童。进行了Kaplan-Meier分析、对数秩检验和比例风险回归分析。
16名（7名女孩）前臂静脉不充足的儿童接受了18例动静脉内瘘构建（12例BVT，6例头臂动静脉内瘘）。中位年龄为14（9-19）岁。BVT和头臂动静脉内瘘的平均（±标准误）手术时间分别为3.4（±0.6）小时和1.9（±0.4）小时。总体2年累积生存率为74%（BVT为66%；头臂动静脉内瘘为83%）。4例动静脉内瘘失败（1例头臂动静脉内瘘，3例BVT），14例动静脉内瘘被截尾（5例，动静脉内瘘通畅；4例，肾移植；2例，非相关死亡；1例，择期转为腹膜透析；1例，手术结扎动静脉内瘘；1例，失访）。18例动静脉内瘘中，6例接受了额外干预（4例，经皮血管成形术；2例，手术取栓）。基于动静脉内瘘类型、既往移植状态、年龄或手术时间的生存时间无显著差异。
头臂动静脉内瘘和BVT动静脉内瘘为前臂静脉不充足而无法构建更远端动静脉内瘘的儿童提供了可靠的血液透析通路。
