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. 2024 Jun 18;13(12):3577.
doi: 10.3390/jcm13123577.

Long-Term Experience of Arterio-Venous Fistula Surgery in Children on Hemodialysis

Veronika Almási-Sperling  1 , Christine Gall  2 , Briain Haney  1 , Nina Latzel  1 , Ferdinand Knieling  3 , Alina C Hilger  3 , Adrian P Regensburger  3 , Alexander Meyer  4   5 , Werner Lang  1 , Ulrich Rother  1
Affiliations

Long-Term Experience of Arterio-Venous Fistula Surgery in Children on Hemodialysis

Veronika Almási-Sperling et al. J Clin Med. .

Abstract

Background: Arterio-venous fistulas (AVF) are used as first-line access for hemodialysis (HD) in the pediatric population. The aim of this investigation was to describe a single-center experience in the creation of AVF, together with its patency in children. Methods: This single-center retrospective study included all patients aged ≤18 years with AVFs created between 1993 and 2023. The collected data included patients' demographics, hemodialysis history, intraoperative data, and required reinterventions in order to determine the impact of these variables on primary, primary-assisted, and secondary patency. Results: Fifty-seven patients were analyzed with a median age of 15 years (range, 7-18 years). Fifty-four forearm and four upper arm fistulas were performed. The median follow-up was 6.9 years (range, 0-23 years). The primary failure rate was 10.5%. The primary patency rate was 67.6%, 53.6%, 51.4%, and 38.1% after 1, 3, 5, and 10 years; primary-assisted patency was 72.9%, 62.8%, 60.6%, and 41.5%; and secondary patency was 87.3%, 81.3%, 76.8%, and 66.6% after 1, 3, 5, and 10 years in the studied population. Conclusions: AVFs showed an acceptable rate of primary failure and excellent long-term patency. In this context, AVFs are an appropriate option for HD access, especially in pediatric patients.

Keywords: arterio-venous fistula; children; long term; primary patency; secondary patency.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Clinical image of an arterio-venous fistula in a 6-year-old boy.
Figure 2
Figure 2
Primary, primary-assisted, and secondary patency rates in the study period.
Figure 3
Figure 3
Study flow chart showing the primary patency over a 10-year period; additionally, the reasons for the end of primary patency are given. The revision procedure was categorized as endo (endovascular procedure), op (surgical revision), or endo + op (endovascular procedure followed by surgical revision).
Figure 4
Figure 4
Comparison of the primary patency rates according to different age categories.
Figure 5
Figure 5
Comparison of primary patency rates according to age-adjusted weight categories.
Figure 6
Figure 6
Time to first cannulation of the fistulas cannulated.
See this image and copyright information in PMC

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