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Microsurgery in Children for Creation of Arteriovenous Fistulas in Renal and Non‐renal Diseases
Author(s) -
Bourquelot Pierre,
Raynaud Fabien,
Pirozzi Nicola
Publication year - 2003
Publication title -
therapeutic apheresis and dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.415
H-Index - 53
eISSN - 1744-9987
pISSN - 1744-9979
DOI - 10.1046/j.1526-0968.2003.00098.x
Subject(s) - medicine , microsurgery , hemodialysis , arteriovenous fistula , surgery , dialysis , population , peritoneal dialysis , end stage renal disease , fistula , catheter , environmental health
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.