Ahmed Okba F, Hamodat Omar M, Kakamad Fahmi H, Abduljabbar Rabea S, Salih Abdulwahid M, Omar Diyar A, Mustafa Mohammed Q, Hassan Marwan N, Mohammed Shvan H, Mikael Tomas M, Najar Kayhan A, Hussen Dahat A
Mosul Cardiac Center, Mousl, Iraq.
Al Jamhori Teaching Hospital, Mousl, Iraq.
Ann Med Surg (Lond). 2021 Nov 23;72:103100. doi: 10.1016/j.amsu.2021.103100. eCollection 2021 Dec.
The feasibility of arteriovenous fistula (AVF) creation in pediatric patients has long been documented, but few studies have evaluated the forms and long-term outcomes. The aim of this article is to highlight the types, techniques and outcomes of AVFs in pediatric age group.
This is multi-center, retrospective, single cohort study, including all the cases of pediatric (less than 18 year old) cases underwent AVF creation during four years (2015-2019). The following data were obtained from the patients' medical records and analyzed; socio-demographics, etiology of renal failure (RF), history of dialysis and transplantation, type and site of AVF, the outcomes and complications.
The study included 108 patients, 89 patients (82.4%) were female. The mean age was 13 years. The most common cause of RF was the urological causes which were found in 34 cases (31.5%), followed by nephrotic syndrome (32 cases, 29.6%), glomerulonephritis (27 cases, 25%), and polycystic kidney disease (12 cases, 11.1%). The decision for choosing access site was performed only by clinical examination in 96 patients (88.9%) while duplex ultrasound was requested for 12 cases (11.1%). The operation was done under local anesthesia in 81 cases (75%) and general anesthesia in 27 cases (25%). The procedure was performed in the wrist in 58 cases (53.7%) and in cubital fossa in 50 cases (46.2%). The most common early complication was hematoma (12 cases, 11.1%), followed by ecchymosis (10 cases, 9.3%), infection (8, 7.4%), seroma (4, 3.7%) and thrombosis (3, 2.8%). The one-year primary patency rate was found in 95 patients (88%) and two-year patency rate in 86 patients (79.6%).
Native AVF in pediatric is the first choice dialysis access even in pediatric population. Radiocephalic in the non-dominant hand is the most preferred site.
儿科患者动静脉内瘘（AVF）建立的可行性早已得到证实，但很少有研究评估其形式和长期结果。本文旨在强调儿科年龄组AVF的类型、技术和结果。
这是一项多中心、回顾性、单队列研究，纳入了在四年（2015 - 2019年）期间接受AVF建立的所有儿科（小于18岁）病例。从患者病历中获取以下数据并进行分析：社会人口统计学、肾衰竭（RF）病因、透析和移植史、AVF的类型和部位、结果及并发症。
该研究纳入108例患者，89例（82.4%）为女性。平均年龄为13岁。RF最常见的病因是泌尿系统病因，共34例（31.5%），其次是肾病综合征（32例，29.6%）、肾小球肾炎（27例，25%）和多囊肾病（12例，11.1%）。96例（88.9%）患者仅通过临床检查来决定选择血管通路部位，12例（11.1%）患者则进行了双功超声检查。81例（75%）手术在局部麻醉下进行，27例（25%）在全身麻醉下进行。58例（53.7%）手术在腕部进行，50例（46.2%）在肘窝进行。最常见的早期并发症是血肿（12例，11.1%），其次是瘀斑（10例，9.3%）、感染（8例，7.4%）、血清肿（4例，3.7%）和血栓形成（3例，2.8%）。95例患者（88%）的一年初次通畅率，86例患者（79.6%）的两年通畅率。
儿科自体AVF即使在儿科人群中也是首选的透析通路。非优势手的桡动脉 - 头静脉内瘘是最优选的部位。
