BACKGROUND: Since the development of operative techniques for arteriovenous fistula (AVF) creation, chronic hemodialysis for treatment of end-stage renal disease in children and young adults became an actual therapeutic option, obviating the need for external shunts. PURPOSE: To report our experience with surgically created AVF in 31 patients, aged 5 to 24 years old, relating long-term fistula patency with risk factors such as arterial hypertension, previous thrombosis events, tendency to hypovolemy, hypercholesterolemy, vein caliber and routine use of the fistula. RESULTS: Overall rate of fistula thrombosis was 22,8%, being 25% in patients weighing less than 20kg and 22,2% in those over 20kg. All fistulas performed on proximal arm veins were patent after 5 to 32 months follow-up. Unused AV fistulas apparently had an increased risk of thrombosis when compared to fistulas routinelly used for hemodialysis access. None of the remainy risk factors studied showed estatistical association with loss of patency. CONCLUSION: AV fistulas can be safely performed in children with success rate comparable to those observed in older patients. Vein caliber and routine use of the fistula appears to have a strong influence on long term patency.
Arteriovenous fistula; hemodialysis; pediatrics; microsurgery