title: AV fistula creation in paediatric patients: outcome is independent of demographics and fistula type reducing usage of venous catheters.
abstract: OBJECTIVE
  Even though early transplantation is still the first-line therapy in paediatric patients with end-stage renal disease (ESRD), up to 30% of these patients still require haemodialysis (HD). Creating an arteriovenous fistula (AVF) is quite challenging, particularly in children, leading to disproportional use of catheters. In this paper, we describe our experience in the creation of AVF with currently no in-dwelling catheters in children and adolescents on HD.
  
  
  METHODS
  From January 2009 to December 2013, there were 34 patients rated as unfit for transplantation for at least the next 6 months or who had already been on HD through a central venous catheter (CVC). Three patients aged between 12 months and 3 years and weighing 9-12 kg were not suitable for AVF. Finally 31 patients, from 6 to 19 years of age with a mean weight of 43.3 ± 14.5 kg (19-80 kg), were assigned to the alternative of AVF.
  
  
  RESULTS
  During the above-mentioned time period, 31 patients were provided with 32 AVFs; 26 received a distal radiocephalic fistula, five a Gracz-type fistula and one a brachio-basilic fistula. All but two fistulae matured primarily, within an average time of 45 (range: 16-191) days until the first dialysis. The fistula's 1-year primary and primary assisted patency rates were 78% and 94%, respectively.
  
  
  CONCLUSIONS
  The creation of a native vascular access is an effective and durable procedure in paediatric and adolescent patients. It reduces using of CVCs and is appropriate both for long-term treatment and as a bridging procedure until renal transplantation.
authors.affiliation: 1 Department of Vascular Surgery, University of Cologne, Cologne - Germany.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Matoussevitch
authors.forename: Christina
authors.initials: C
authors.lastname: Taylan
authors.forename: Klaus
authors.initials: K
authors.lastname: Konner
authors.forename: Michael
authors.initials: M
authors.lastname: Gawenda
authors.forename: Kathrin
authors.initials: K
authors.lastname: Kuhr
authors.forename: Bernd
authors.initials: B
authors.lastname: Hoppe
authors.forename: Jan
authors.initials: J
authors.lastname: Brunkwall
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D002405:Catheterization, Central Venous / Q000295:instrumentation* / Q000706:statistics & numerical data; D002408:Catheters, Indwelling / Q000706:statistics & numerical data; D062905:Central Venous Catheters / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D016030:Kidney Transplantation; D008297:Male; D006435:Renal Dialysis; D012307:Risk Factors; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*; D014654:Vascular Patency; D014680:Veins / Q000503:physiopathology / Q000637:transplantation*; D014850:Waiting Lists; D055815:Young Adult