Department of Surgery, The University of Oklahoma, College of Medicine, Tulsa, Okla.
Servicio de Nefrología, Hipertensión, Diálisis y Trasplante, Departamento de Pediatría, Hospital Roosevelt/FUNDANIER, Guatemala City, Guatemala.
J Vasc Surg. 2019 Nov;70(5):1635-1641. doi: 10.1016/j.jvs.2019.02.022. Epub 2019 May 21.
The Guatemalan Foundation for Children with Kidney Diseases was established in 2003 as the first and only comprehensive pediatric nephrology program and hemodialysis unit in Guatemala. Bridge of Life (BOL) is a not-for-profit charitable organization focused on chronic kidney disease and supplied equipment, training and support during formation of the hemodialysis unit. Pediatric permanent vascular access (VA) expertise had not been established and noncuffed dialysis catheters provided almost all VA, many through subclavian vein access sites. BOL assistance was requested for establishing a VA surgical program, resulting in recurring BOL surgical missions to create arteriovenous fistulas (AVF) in these children. This study analyzes the BOL pediatric VA missions to Guatemala.
Three surgical pediatric VA missions were conducted in Guatemala from 2015 to 2017. Each mission was led by two or three surgeons. All supplies and equipment (including ultrasound units) were taken as part of each mission. The BOL surgical VA mission teams work with local pediatric surgeons, pediatric nephrologists, and dialysis nurses to establish collegial relationships and foster teaching interactions. We retrospectively reviewed the patient demographic data, procedures, and outcomes for these missions.
AVFs were created in 54 new pediatric patients. Ages were 8 to 19 years (13.4 ± 2.8 years) and 29 patients (54%) were male. Patient weights were 28 to 50 kg (30.8 ± 8.3 kg) with body mass indexes of 12 to 25 kg/m (17.9 ± 2.9 kg/m). Radiocephalic AVFs were created in 21 children (39%), proximal radial artery AVFs in 12 (22%). and brachial artery inflow AVFs in 5 (9%). Sixteen patients (30%) required transpositions and one a translocation; two of these were femoral procedures. Primary and cumulative patency rates were 83% and 85% at 12 months and 62% and 85% at 36 months, respectively. The median follow-up was 17 months. Interventions with fistulagram and balloon angioplasty options were not available for AVF dysfunction or access salvage during the study period. However, six patients underwent an AVF revision and salvage during subsequent missions or by one of the Guatemalan surgeons (R.S.). Four individuals underwent successful transplantation during the study period. There were no operative deaths or major complications.
Pediatric VA missions to Guatemala created safe and functional AVFs in concert with local pediatric surgeons and pediatric nephrologists. Three surgical missions included access operations in 54 new patients. Cumulative AVF patency was 85% at 36 months.
危地马拉儿童肾脏病基金会成立于 2003 年，是危地马拉第一家也是唯一一家综合性儿科肾病学计划和血液透析单位。生命之桥（BOL）是一个非营利慈善组织，专注于慢性肾脏病，并在血液透析单位成立期间提供设备、培训和支持。儿科永久性血管通路（VA）专业知识尚未建立，无袖带透析导管几乎提供了所有 VA，其中许多通过锁骨下静脉进入部位。BOL 被要求建立 VA 外科项目，导致 BOL 外科任务反复前往危地马拉为这些儿童创建动静脉瘘（AVF）。本研究分析了 BOL 儿科 VA 对危地马拉的任务。
2015 年至 2017 年期间，在危地马拉进行了三次小儿 VA 外科任务。每次任务都由两到三名外科医生领导。每次任务都携带了所有的用品和设备（包括超声仪）。BOL 外科 VA 任务团队与当地儿科外科医生、儿科肾病学家和透析护士合作，建立了同事关系，并促进了教学互动。我们回顾性地审查了这些任务的患者人口统计学数据、程序和结果。
在 54 名新儿科患者中创建了 AVF。年龄为 8 至 19 岁（13.4±2.8 岁），29 名患者（54%）为男性。患者体重为 28 至 50kg（30.8±8.3kg），体重指数为 12 至 25kg/m（17.9±2.9kg/m）。21 名儿童（39%）创建了头静脉 AVF，12 名儿童（22%）创建了桡动脉近端 AVF，5 名儿童（9%）创建了肱动脉流入 AVF。16 名患者（30%）需要转位，1 名患者需要转位；其中 2 例为股部手术。12 个月时，一级和累计通畅率分别为 83%和 85%，36 个月时分别为 62%和 85%。中位随访时间为 17 个月。在研究期间，AVF 功能障碍或通路挽救时，没有瘘管造影和球囊血管成形术的选择。然而，在随后的任务中，有 6 名患者进行了 AVF 修复和挽救，或者由危地马拉外科医生之一（R.S.）进行了修复和挽救。在研究期间，有 4 人成功进行了移植。没有手术死亡或重大并发症。
危地马拉的儿科 VA 任务与当地儿科外科医生和儿科肾病学家一起创建了安全有效的 AVF。三次外科手术任务包括 54 名新患者的通路手术。36 个月时，AVF 通畅率累计为 85%。
