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Long-term outcomes of staged basilic vein transposition for hemodialysis access in children

Abstract

Introduction

Children requiring long-term hemodialysis often face significant challenges due to their young age and small-vessel caliber for arteriovenous (AV) access creation. In this study, we report our experience of staged basilic vein transposition (BVT) in pediatric patients.

Methods

All patients undergoing staged BVT at a tertiary care pediatric hospital from 2003 to 2015 were reviewed. Indications for staged BVT included inadequate cephalic conduit or failed AV fistula using cephalic vein. Pertinent clinical variables were analyzed to determine treatment outcomes.

Results

Forty-two children (24 males, 57%) underwent 46 staged BVT during the study period. Median age was 12.8 ± 4.8 years (range 3-18). The mean weight was 47 ± 5.1 kg (range, 13-126 kg), with four children (10%) weighing ≤20 kg. Mean operative times for initial brachiobasilic AV fistula and staged BVT were 39 ± 12 minutes and 66 ± 17 minutes, respectively. Mean follow-up period was 5.4 ± 1.8 years. Functional maturation was achieved in 93% of BVTs. Early fistula thrombosis within 30 days following BVT occurred in four patients (10%). Late BVT thrombosis occurred in 13 patients (31%). Primary patency rates at 2 years and 4 years were 78% and 72%, respectively. Secondary patency rates at 2 years and 4 years were 86% and 82%, respectively.

Conclusions

Staged BVT is a durable and reliable autologous hemodialysis access in children who do not have adequate cephalic venous conduit.

J Vasc Access 2017; 18(5): 366 - 370

Article Type: ORIGINAL RESEARCH ARTICLE

DOI:10.5301/jva.5000778

Authors

Elias Kfoury, Christopher J. Demaree, Mun J. Poi, Jesus M. Matos, Carlos F. Bechara, Peter H. Lin

Article History

Disclosures

Financial support: No grants or funding have been received for this study.
Conflict of interest: None of the authors has financial interest related to this study to disclose.

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Authors

Affiliations

  • Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX - USA
  • Department of Cardiothoracic and Vascular Surgery, Houston Methodist Hospital, Houston, TX - USA
  • University Vascular Associates, Los Angeles, CA - USA

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