Microsurgery in children for creation of arteriovenous fistulas in renal and non-renal diseases

被引:33
作者
Bourquelot, P [1 ]
Raynaud, F [1 ]
Pirozzi, N [1 ]
机构
[1] Clin Jouvenet, Angioaccess Dept, F-75016 Paris, France
来源
THERAPEUTIC APHERESIS AND DIALYSIS | 2003年 / 7卷 / 06期
关键词
arteriovenous fistula; children; end-stage renal disease; hemodialysis; microsurgery;
D O I
10.1046/j.1526-0968.2003.00098.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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 karteriovenous fistulas (AVF) varied from 54 to 76% without microsurgery, and from 0 to 14% with microsurgery. Similarly, the percentages of AVE 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 AVE. 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 I 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 AVE 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.
引用
收藏
页码:498 / 503
页数:6
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