Kfoury Elias, Demaree Christopher J, Poi Mun J, Matos Jesus M, Bechara Carlos F, Lin Peter H
Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX - USA.
Department of Cardiothoracic and Vascular Surgery, Houston Methodist Hospital, Houston, TX - USA.
J Vasc Access. 2017 Sep 11;18(5):366-370. doi: 10.5301/jva.5000778. Epub 2017 Jul 29.
Children requiring long-term hemodialysis often face significant challenges due to their young age and small-vessel caliber for arteriovenous (AV) access creation. In this study, we report our experience of staged basilic vein transposition (BVT) in pediatric patients.
All patients undergoing staged BVT at a tertiary care pediatric hospital from 2003 to 2015 were reviewed. Indications for staged BVT included inadequate cephalic conduit or failed AV fistula using cephalic vein. Pertinent clinical variables were analyzed to determine treatment outcomes.
Forty-two children (24 males, 57%) underwent 46 staged BVT during the study period. Median age was 12.8 ± 4.8 years (range 3-18). The mean weight was 47 ± 5.1 kg (range, 13-126 kg), with four children (10%) weighing ≤20 kg. Mean operative times for initial brachiobasilic AV fistula and staged BVT were 39 ± 12 minutes and 66 ± 17 minutes, respectively. Mean follow-up period was 5.4 ± 1.8 years. Functional maturation was achieved in 93% of BVTs. Early fistula thrombosis within 30 days following BVT occurred in four patients (10%). Late BVT thrombosis occurred in 13 patients (31%). Primary patency rates at 2 years and 4 years were 78% and 72%, respectively. Secondary patency rates at 2 years and 4 years were 86% and 82%, respectively.
Staged BVT is a durable and reliable autologous hemodialysis access in children who do not have adequate cephalic venous conduit.
需要长期血液透析的儿童由于年龄小且动静脉（AV）通路建立的血管口径小，常常面临重大挑战。在本研究中，我们报告了小儿患者分期贵要静脉转位术（BVT）的经验。
回顾了2003年至2015年在一家三级儿科医院接受分期BVT的所有患者。分期BVT的适应症包括头静脉导管不足或使用头静脉的AV内瘘失败。分析相关临床变量以确定治疗结果。
在研究期间，42名儿童（24名男性，57%）接受了46次分期BVT。中位年龄为12.8±4.8岁（范围3 - 18岁）。平均体重为47±5.1千克（范围13 - 126千克），4名儿童（10%）体重≤20千克。初次肱贵要AV内瘘和分期BVT的平均手术时间分别为39±12分钟和66±17分钟。平均随访期为5.4±1.8年。93%的BVT实现了功能成熟。4名患者（10%）在BVT后30天内发生早期内瘘血栓形成。13名患者（31%）发生晚期BVT血栓形成。2年和4年的初级通畅率分别为78%和72%。2年和4年的次级通畅率分别为86%和82%。
对于没有足够头静脉导管的儿童，分期BVT是一种持久且可靠的自体血液透析通路。
