Vol. 8, Issue 3, Part A (2024)

Introduction: Arteriovenous fistula is the vascular access of choice in children on hemodialysis. However, creation and maintenance of arteriovenous fistula in children has unique challenges.

Aim of Study: To determine the predictors of success of brachiocephalic fistula for hemodialysis in pediatric age group.

Methods: This prospective study was conducted on (34) children (? 18 years of age) with end stage renal disease referred to the Vascular and Endovascular Surgery Department in Tanta University Hospitals for arteriovenous fistula creation for hemodialysis purpose from the beginning of April 2021 till the end of March 2023. Full history taking, clinical examination and duplex ultrasound vascular mapping was performed with minimal used arterial diameter of 2 mm and minimal vein diameter of 2.5 mm. All arteriovenous fistulae were created in end to side anastomosis with a continuous running suture using 7/0 prolene suture.

Results: 34 children were included in this study with mean age of 11.56±2.53 years ranging from 7-16 years and the mean weight was 32.29±9.18 Kg ranging from 18-54 Kg. 33 children (97.1%) had already started hemodialysis through temporary central venous catheters on presentation. The mean arterial diameter was 2.59±0.37 mm ranging from 2-4 mm. While the mean vein diameter was 3.21±0.50 mm ranging from 2.5-4.4 mm. Successful maturation occurred in 33 cases (97.1%) while primary failure occurred in 1 case due to failed maturation and thrombosis. After 1 year the primary patency rate was (82.4%). While secondary patency rate was (94.1%). No statistically significant correlations to (age, weight, etiology of renal failure, associated comorbidities, artery diameter, flow volume, vein diameter and arteriotomy length).

Conclusions: Success of brachiocephalic fistula in pediatric patients is predicted provided that preoperative child selection and duplex US vascular mapping is routinely used for evaluation of child vessels suitability with minimally used arterial diameter of 2 mm and minimal vein diameter of 2.5 mm, arteriotomy length of 3-5 mm with arteriovenous fistula creation in end to side anastomosis with a continuous running suture using 7/0 prolene suture, using metal dilators to overcome arterial spasm just before tying the last stitch and routine postoperative follow up for early detection of complications to achieve arteriovenous fistula maintenance.