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.
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.
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.
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
AuthorsElias Kfoury, Christopher J. Demaree, Mun J. Poi, Jesus M. Matos, Carlos F. Bechara, Peter H. Lin
- • Accepted on 10/06/2017
- • Available online on 29/07/2017
- • Published in print on 11/09/2017
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- Kfoury, Elias [PubMed] [Google Scholar] 1
- Demaree, Christopher J. [PubMed] [Google Scholar] 1
- Poi, Mun J. [PubMed] [Google Scholar] 1
- Matos, Jesus M. [PubMed] [Google Scholar] 1
- Bechara, Carlos F. [PubMed] [Google Scholar] 2
- Lin, Peter H. [PubMed] [Google Scholar] 1, 3, * Corresponding Author (firstname.lastname@example.org)
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