Kim Suh Min, Min Seung-Kee, Ahn Sanghyun, Min Sang-Il, Ha Jongwon
Department of Surgery, Dongguk University Ilsan Hospital, Goyang, Korea.
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Vasc Specialist Int. 2016 Sep;32(3):113-118. doi: 10.5758/vsi.2016.32.3.113. Epub 2016 Sep 30.
This retrospective review aimed to report the outcomes of arteriovenous fistula (AVF) and to evaluate the suitability of AVF as a permanent vascular access in pediatric populations.
Data were collected for all patients aged 0 to 19 years who underwent AVF creation for hemodialysis between January 2000 and June 2014.
Fifty-two AVFs were created in 47 patients. Mean age was 15.7±3.2 years and mean body weight was 46.7±15.4 kg. Of the 52 AVFs, 43 were radiocephalic AVFs, 7 were brachiocephalic AVFs and 2 were basilic vein transpositions. With a mean follow-up of 49.7±39.2 months, primary patency was 60.5%, 51.4%, and 47.7% at 1, 3, and 5 years, respectively and secondary patency was 82.7%, 79.2% and 79.2% at 1, 3, and 5 years, respectively. Age, body weight, AVF type, the presence of a central venous catheter, use of anticoagulation therapy, and history of vascular access failure were not significantly associated with patency rates. There were 9 cases (17.3%) of primary failure; low body weight was an independent predictor. Excluding cases of primary failure, the mean duration of maturation was 10.0±3.7 weeks. During follow-up, 20 patients (42.6%) underwent kidney transplantation, with a median interval to transplantation of 36 months.
AVF creation in children and adolescents is associated with acceptable long-term durability, primary failure rate and maturation time. Considering the waiting time and limited kidney graft survival, placement of AVFs should be considered primarily even in patients expected to receive transplantation.
本回顾性研究旨在报告动静脉内瘘（AVF）的治疗结果，并评估AVF作为儿科患者永久性血管通路的适用性。
收集2000年1月至2014年6月期间接受AVF造瘘术进行血液透析的所有0至19岁患者的数据。
47例患者共创建了52个AVF。平均年龄为15.7±3.2岁，平均体重为46.7±15.4kg。52个AVF中，43个为桡动脉-头静脉内瘘，7个为肱动脉-头静脉内瘘，2个为贵要静脉转位。平均随访时间为49.7±39.2个月，1年、3年和5年的初次通畅率分别为60.5%、51.4%和47.7%，二次通畅率分别为82.7%、79.2%和79.2%。年龄、体重、AVF类型、中心静脉导管的存在、抗凝治疗的使用以及血管通路失败史与通畅率无显著相关性。有9例（17.3%）初次失败；低体重是独立预测因素。排除初次失败病例后，平均成熟时间为10.0±3.7周。随访期间，20例患者（42.6%）接受了肾移植，移植的中位间隔时间为36个月。
儿童和青少年AVF造瘘术具有可接受的长期耐用性、初次失败率和成熟时间。考虑到等待时间和肾移植存活期有限，即使是预期接受移植的患者，也应首先考虑放置AVF。
