All natural pediatric vascular accesses

الملخص EN

Background: Therapy of pediatric patients with end stage renal disease (ESRD) has been carried out using hemodialysis, peritoneal dialysis and renal transplantation.

In developing countries regular hemodialysis is the more popular line of management rather than renal transplantation therefore the availability, durability, and maintenance of vascular access in pediatric population with ESRD is a continuous challenge to the vascular surgeon.

The use of natural, i.e.

autogenous veins to create a vascular access in pediatric population with ESRD does have many advantages, as being more durable and resistant to infections also more economic and delay the use of prosthetic grafts to adult life.

Aims: This prospective study aim is to provide more stable renal replacement therapy through hemodialysis, by creation of vascular access in pediatric population with ESRD using only natural conduits and taking the body weight of the child as a guideline determining the site of the procedure, while using parachuting technique during the anastomosis between the artery and vein in all cases of the study.

Methods: During the period from June 2003 to June 2006, one hundred forty-four children aging between 3 and 14 years and weighing between 8-30 kilograms, required renal replacement therapy for ESRD, in the Center of Pediatric Nephrology and Transplantation, Aboulreesh children Hospital, Cairo University, All underwent operations to create vascular accesses for hemodialysis using natural conduits i.e.

autogenous veins, anastomoses were done by a single modified surgical method while choice of the procedure site was according to availability of veins and the weight of the child, and was followed up for an average of 24 months.

Results:One hundred and seventy nine surgical procedures done to the one hundred forty-four patients, over the period of the study.

Thrombosis of the vascular access during the first 3 months occurred in 12 patients (8.3%) and after 3 months in 13 patients (9%), secondary hemorrhage in 6 patients (4%), aneurismal dilation in 3 patients (2%), while other complications each was less than (1%).

Conclusion: Natural vascular access is a reasonable option for hemodialysis in pediatric patients with ESRD, the use of body weight of the child as a guideline for the choice of the procedure site, along with the use of parachuting technique may improve the outcome.