Hemodialysis via the Scribner shunt in childhood: a surgical evaluation.
From 1973 to 1988, 105 children with renal failure (average age, 6.5 years; range, 5 days to 16.2 years) were treated with hemodialysis via surgically implanted Scribner shunts (n = 120). The average duration of dialysis was 16 days (range, 1 to 194 days). Twenty-three patients died during treatment or during the hospital stay because of the underlying disease; no patient died because of shunt complications. The treatment was initially successful for 82 children, but 14 of them died within several months of discharge. Among the initially surviving 82 patients, the shunt was the only means of access for dialysis in 52. In the other 30, the primary Scribner shunt was unsuccessful; it required replacement, or the type of dialysis had to be changed. The shunts were implanted in the forearm in 23%, the groin in 40%, and the ankle in 37%. Early complications were local bleeding (17%) after an average of 37.3 days, shunt occlusion (34%) after an average of 47.3 days, infections (9.3%) after an average of 43.9 days, and decreased blood flow (8.5%) after an average of 47.7 days. Vessels were reconstructed after discontinuation of dialysis in 28 cases, in which the Scribner shunt had been implanted in the groin. No patient experienced immediate ischemic problems. Long-term follow up results were obtained for 60% (n = 40) of the surviving 68 children after an average of 7 years (range, 2.1 to 15.2 years). We found no evidence of arterial or venous complications at the former shunt site.(ABSTRACT TRUNCATED AT 250 WORDS)
Department of Surgery, University of Cologne, Germany.
R
R
Huber
T
T
von Lilien
P M
PM
Huber
S
S
Anstöss
T
T
Schmitz-Rixen
H
H
Erasmi
D058186:Acute Kidney Injury / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D008297:Male; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome