Arterio-venous fistula for automated red blood cells exchange in patients with sickle cell disease: Complications and outcomes.
Erythrocytapheresis (ER) can improve outcome in patients with sickle cell disease (SCD). A good vascular access is required but frequently it can be difficult to obtain for sickle cell patients. Arterio-venous fistulas (AVFs) have been suggested for ER in SCD supported by limited evidence. We report the largest cohort of ER performed with AVFs from three French SCD reference centers. Data of SCD patients undergoing ER with AVFs in the French SCD reference center were retrospectively collected. The inclusion criteria were: SS or Sβ-Thalassemia and AVF surgery for ER. SCD-related complications, transfusion history, details about AVF surgical procedure, echocardiographic data before and after AVF, AVF-related surgical and hemodynamical complications were collected. Twenty-six patients (mean age 20.5 years, mean follow-up 68 months [11-279]) were included. Twenty-three patients (88.5%) required central vascular access before AVF. Fifteen AVFs (58%) were created on the forearm and 11 (42%) on the arm. Nineteen patients (73%) had stenotic, thrombotic or infectious AVF complications. A total of 0.36 stenosis per 1,000 AVF days, 0.37 thrombosis per 1,000 AVF days and 0.078 infections per 1.000 AVF days were observed. The mean AVF lifespan was 51 months [13-218]. One patient with severe pulmonary hypertension worsened after AVF creation and died. We report the first series of SCD patients with AVF for ER, demonstrating that AVFs could be considered as a potential vascular access for ER. Patients with increased risk for hemodynamic intolerance of AVFs must be carefully identified, so that alternative vascular accesses can be considered. Am. J. Hematol. 92:136-140, 2017. © 2016 Wiley Periodicals, Inc.
Biotherapy department, Necker-Enfants-Malades-University Hospital, APHP, Université Paris 5, Paris, France.|Centre de Référence des Syndromes Drépanocytaires Majeurs, Necker-Enfants-Malades-University Hospital, APHP, Université Paris 5, Paris, France.
Marianne
M
Delville
Biotherapy department, Necker-Enfants-Malades-University Hospital, APHP, Université Paris 5, Paris, France.
Sandra
S
Manceau
Centre de Référence des Syndromes Drépanocytaires Majeurs, Henri Mondor University Hospital, APHP, Université Paris-Est Créteil, France.
Nassim
N
Ait Abdallah
Vascular surgery department, La Roseraie Clinic, Aubervilliers, France.
Jan
J
Stolba
Interventional Radiology Clinique Labrouste, Paris, France.
Sameh
S
Awad
Cardiology Department, Henri Mondor University Hospital, APHP, Université Paris-Est Créteil, France.
Thibaud
T
Damy
Cardiology Department, Henri Mondor University Hospital, APHP, Université Paris-Est Créteil, France.|ELSAN, Polyclinique de Poitiers, France.
Barnabas
B
Gellen
Cardiology department, Necker Enfants malades university Hospital, APHP, Université Paris 5, France.
Laurent
L
Sabbah
Centre de Référence des Syndromes Drépanocytaires Majeurs, Henri Mondor University Hospital, APHP, Université Paris-Est Créteil, France.
Karima
K
Debbache
Nephrology and Renal Transplantation Department Henri Mondor University Hospital, APHP, Université Paris-Est Créteil, France.
Vincent
V
Audard
Etablissement français du sang, Henri Mondor University Hospital, APHP, Université Paris-Est Créteil, France.
Jean-Louis
JL
Beaumont
Pediatrics Department, Centre hospitalier intercommunal de Créteil, Créteil, France.
Cécile
C
Arnaud
Department of Internal medicine, Bicetre University Hospital, Université Paris 11, le Kremlin-Bicêtre, France.
Christelle
C
Chantalat-Auger
Department of Internal medicine, Bicetre University Hospital, Université Paris 11, le Kremlin-Bicêtre, France.
Françoise
F
Driss
Biotherapy department, Necker-Enfants-Malades-University Hospital, APHP, Université Paris 5, Paris, France.
François
F
Lefrère
Biotherapy department, Necker-Enfants-Malades-University Hospital, APHP, Université Paris 5, Paris, France.|Centre de Référence des Syndromes Drépanocytaires Majeurs, Necker-Enfants-Malades-University Hospital, APHP, Université Paris 5, Paris, France.
Marina
M
Cavazzana
Clinique Arago, Paris, France.
Gilbert
G
Franco
Centre de Référence des Syndromes Drépanocytaires Majeurs, Henri Mondor University Hospital, APHP, Université Paris-Est Créteil, France.
Frederic
F
Galacteros
Biotherapy department, Necker-Enfants-Malades-University Hospital, APHP, Université Paris 5, Paris, France.|Centre de Référence des Syndromes Drépanocytaires Majeurs, Necker-Enfants-Malades-University Hospital, APHP, Université Paris 5, Paris, France.
Jean-Antoine
JA
Ribeil
Centre de Référence des Syndromes Drépanocytaires Majeurs, Henri Mondor University Hospital, APHP, Université Paris-Est Créteil, France.|Internal Medicine Department, Poitiers University Hospital, Poitiers, France.
Justine
J
Gellen-Dautremer
D000293:Adolescent; D000328:Adult; D000755:Anemia, Sickle Cell / Q000097:blood / Q000628:therapy*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods*; D001781:Blood Component Removal / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D003251:Constriction, Pathologic / Q000453:epidemiology / Q000209:etiology; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007501:Iron / Q000097:blood; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome; D055815:Young Adult
D007501:Iron