Long-term safety and feasibility of arteriovenous fistulae as vascular accesses in children with haemophilia: a prospective study.
Infectious and thrombotic complications limit the long-term use of subcutaneous ports as venous accesses for children with haemophilia. This study has evaluated for the first time the safety and feasibility of internal arteriovenous fistulae (AVF) as alternative accesses. During the 3-year study period, 27 severe haemophiliacs, 14 with factor VIII inhibitors (52%), underwent the creation of 31 proximal AVF in the forearm. Mild forearm haematomas were observed after five procedures (16%) in five patients who had or developed inhibitors after surgery. Inadequate AVF maturation was observed after five of 31 procedures (16%) in four children. AVF were first accessed after a median of 42 d and regularly used at home by 26 patients (96%) for a median follow-up period of 29 months. Thrombosis of a venous branch occurred in one AVF (3%) after 9 months of uncomplicated use in a child with inhibitor who spontaneously recovered from the symptoms and still used AVF for nine additional months. Mild symptoms, referable to distal ischaemia, were transiently reported by two children (7%) who needed no remedial intervention. This study demonstrates that the use of AVF in haemophiliacs enabled long-term treatment at home in all patients but one.
Santagostino
Elena
E
Department of Internal Medicine, A Bianchi Bonomi Haemophilia and Thrombosis Centre, IRCCS Maggiore Hospital and University of Milan, Milan, Italy.
Gringeri
Alessandro
A
Berardinelli
Luisa
L
Beretta
Claudio
C
Muça-Perja
Myrvet
M
Mannucci
Pier Mannuccio
PM
D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D015944:Factor VIIIa / Q000008:administration & dosage*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006225:Hand / Q000098:blood supply; D006406:Hematoma; D006467:Hemophilia A / Q000628:therapy*; D006801:Humans; D007223:Infant; D007511:Ischemia; D008297:Male; D011183:Postoperative Complications; D011446:Prospective Studies; D020246:Venous Thrombosis / Q000209:etiology
D015944:Factor VIIIa