Kamath Nivedita, Naik Naveen, Iyengar Arpana
Department of Pediatric Nephrology, St John's Medical College Hospital, Bengaluru, India.
Department of Pediatric Nephrology, St John's Medical College Hospital, Bengaluru, India.
J Vasc Surg. 2022 Dec;76(6):1699-1703. doi: 10.1016/j.jvs.2022.06.098. Epub 2022 Jul 8.
Arteriovenous fistula (AVF) is the recommended access of choice in children on maintenance hemodialysis. The challenges of creating and maintaining a fistula in children are many. The objective of our study was to describe the clinical profile and outcomes of AVFs in children from a resource-limited setting.
A retrospective analysis of children who have had an AVF for maintenance hemodialysis from 2010 to 2020 was performed. The center protocol for creation and management of complications was followed. Failure of fistula to mature was defined as primary failure. Primary patency was defined as the time from creation of access to the first complication requiring intervention. The primary failure rate, duration of primary patency and associated risk factors, and 1- and 3-year primary fistula patency rates were studied.
Thirty-six children (38 AVFs) with the median (interquartile range) age of 11 (8, 13) years were included. Brachiocephalic anastomosis was the most common site (75%) of AVF. The primary failure rate was 5.5% (2 of 36). The mean (95% confidence interval) duration of primary patency was 42.3 (29.9, 54.7) months. There were no particular factors associated with the duration of primary patency. The 1- and 3-year primary patency rate was 91% and 73%, respectively.
In resource-limited settings, AVF had good primary patency and is a feasible and durable access for maintenance hemodialysis in children.
动静脉内瘘（AVF）是维持性血液透析儿童推荐的首选血管通路。在儿童中建立和维持内瘘面临诸多挑战。我们研究的目的是描述资源有限地区儿童动静脉内瘘的临床特征及结局。
对2010年至2020年期间接受动静脉内瘘进行维持性血液透析的儿童进行回顾性分析。遵循中心制定的内瘘建立及并发症管理方案。内瘘未成熟失败定义为原发性失败。原发性通畅定义为从建立血管通路到首次需要干预的并发症出现的时间。研究原发性失败率、原发性通畅持续时间及相关危险因素，以及1年和3年原发性内瘘通畅率。
纳入36名儿童（38个动静脉内瘘），年龄中位数（四分位间距）为11（8，13）岁。头臂吻合是动静脉内瘘最常见的部位（75%）。原发性失败率为5.5%（36例中的2例）。原发性通畅的平均（95%置信区间）持续时间为42.3（29.9，54.7）个月。没有与原发性通畅持续时间相关的特定因素。1年和3年原发性通畅率分别为91%和73%。
在资源有限地区，动静脉内瘘具有良好的原发性通畅性，是儿童维持性血液透析可行且持久的血管通路。
