Endovascular intervention in the maintenance and rescue of paediatric arteriovenous fistulae for hemodialysis.

BACKGROUND: Arteriovenous fistulae (AVF) provide superior primary vascular access for children on chronic dialysis compared to central venous catheters (CVC). However, AVFs inevitably develop complications and will require some intervention to maintain long-term functional patency.

METHODS: We report an 'endovascular-first' approach to the maintenance and rescue of paediatric AVFs. Thirty interventions targeting 46 lesions in 18 children (median age 11 years [range 5-17]) were performed. Sixty-eight percent of the AVFs were brachio-cephalic fistulae, 26% brachio-basilic fistulae and 5% radio-cephalic fistulae. Immediate functional success was 86% with good dialysis adequacy (mean urea reduction ratio > 70%) at 3 months post procedure.

RESULTS: There was one significant complication, consisting of an AVF rupture which was managed with a covered stent.

CONCLUSIONS: Repeated interventions may be necessary to maintain AVF patency and avoid central venous catheters. This is the largest series reported to date.