Microsurgery in children for creation of arteriovenous fistulas in renal and non-renal diseases.
Microsurgery for angioaccess in children includes the use of a surgical microscope, microsurgical instruments, prophylactic tourniquet-induced hemostasis and no-touch surgery. In the recent publications concerning angioaccess in children, the percentages of grafts versus arteriovenous fistulas (AVF) varied from 54 to 76% without microsurgery, and from 0 to 14% with microsurgery. Similarly, the percentages of AVF which failed to mature varied from 30 to 33% without microsurgery, and from 5 to 10% with microsurgery. In a personal series of 380 children receiving hemodialysis, 434 microsurgical angioaccesses were created, 78% being distal autologous AVF. Eighty-five percent of the distal radial-cephalic AVF were patent after 2 years and 60% after 4 years. These results of microsurgically created AVF are probably responsible, at least in part, for the high percentage of end-stage renal disease (ESRD) children treated by hemodialysis on 1 February 2003 in Paris using an autologous fistula (70% of 33 children), while only 24% were hemodialyzed via a central venous catheter and 6% were on peritoneal dialysis. This compares favorably with the annual publication of the North American Pediatric Renal Transplant Cooperative Study in 1996 reporting that two-thirds of the dialysis population were maintained on peritoneal dialysis and that the majority of hemodialysis accesses were external percutaneous catheters. Microsurgical AVF are also created successfully in non-ESRD children requiring frequent blood access for various chronic diseases. It has been possible to create a distal AVF in 68% of cases and the long-term patency rate was just below 60% after 10 years. Microsurgery is mandatory for creation of arteriovenous fistulas, the best form of angioaccess for children treated by hemodialysis or requiring repeated access to blood in various non-renal diseases.
Bourquelot
Pierre
P
Angioaccess Department, Clinique Jouvenet, Paris, France. pbourquelot@magic.fr
Raynaud
Fabien
F
Pirozzi
Nicola
N
D000367:Age Factors; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods*; D002408:Catheters, Indwelling / Q000592:standards / Q000639:trends; D002675:Child, Preschool; D003251:Constriction, Pathologic; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D007223:Infant; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008866:Microsurgery / Q000009:adverse effects / Q000379:methods*; D006435:Renal Dialysis / Q000379:methods; D012086:Reoperation; D012307:Risk Factors; D014654:Vascular Patency