title: Microsurgery in gaining paediatric vascular access for haemodialysis.
abstract: One hundred and one surgical procedures performed in children for construction and maintenance of vascular accesses for haemodialysis were retrospectively analyzed. There were 86 operations performed to create a new fistula in patients without vascular access or with nonrecoverable failed angio-access. Fifteen surgical procedures were performed to treat fistula complications. The new fistulas were radiocephalic n = 60 (70%), ulnar-basilic n = 5 (5.8%), antecubital n = 9 (10.3%), and PTFE grafts n = 12 (14%). Microsurgical techniques were used in all cases, including PTFE graft fistulas. A microscope was used in 56 cases (55.4%) and magnifying loupes (x 2.5 magnification) in the rest of the operations. Early-failure rate for radiocephalic fistulas was 10%. Cumulative patency rates in radiocephalic fistulas were 79%, 75%, and 70% at 1, 2, and 5 years, respectively. No statistical differences were found from the cumulative patency curve of 730 radial-cephalic fistulas performed in adults during the same period of time. Radiocephalic fistulas can be constructed in most paediatric cases using microsurgical technique. Elbow fistulas can be the second-choice vascular access, and PTFE grafts can be reserved for children with exhaustion of autologous veins. Brachial-jugular PTFE grafts can be used in cases of subclavian vein stenosis.
authors.affiliation: Department of General Surgery, Hospital Gregorio Marañón, Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Sanabia
authors.forename: J R
authors.initials: JR
authors.lastname: Polo
authors.forename: M D
authors.initials: MD
authors.lastname: Morales
authors.forename: M J
authors.initials: MJ
authors.lastname: Canals
authors.forename: J
authors.initials: J
authors.lastname: Polo
authors.forename: A
authors.initials: A
authors.lastname: Serantes
mesh_terms: D000293:Adolescent; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D001807:Blood Vessel Prosthesis; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D008866:Microsurgery / Q000379:methods*; D006435:Renal Dialysis; D012086:Reoperation; D014654:Vascular Patency / Q000502:physiology