HEMODIALYSIS VIA THE SCRIBNER SHUNT IN CHILDHOOD - A SURGICAL EVALUATION

From 1973 to 1988, 105 children with renal failure (average age, 6.5 y ears; range, 5 days to 16.2 years) were treated with hemodialysis via surgically implanted Scribner shunts (n = 120). The average duration o f dialysis was 16 days (range, 1 to 194 days). Twenty-three patients d ied during treatment or during the hospital stay because of the underl ying disease; no patient died because of shunt complications. The trea tment was initially successful for 82 children, but 14 of them died wi thin several months of discharge. Among the initially surviving 82 pat ients, the shunt was the only means of access for dialysis in 52. In t he other 30, the primary Scribner shunt was unsuccessful; it required replacement, or the type of dialysis had to be changed. The shunts wer e implanted in the forearm in 23%, the groin in 40%, and the ankle in 37%. Early complications were local bleeding (17%) after an average of 37.3 days, shunt occlusion (34%) after an average of 47.3 days, infec tions (9.3%) after an average of 43.9 days, and decreased blood flow ( 8.5%) after an average of 47.7 days. Vessels were reconstructed after discontinuation of dialysis in 28 cases, in which the Scribner shunt h ad been implanted in the groin. No patient experienced immediate ische mic problems. Long-term follow up results were obtained for 60% (n = 4 0) of the surviving 68 children after an average of 7 years (range, 2. 1 to 15.2 years). We found no evidence of arterial or venous complicat ions at the former shunt site. Among the patients whose shunt had been located in the groin, there was growth of up to two shoe sizes in two cases and a pathological ankle Doppler index in six cases, hut duplex sonography proved the reconstructed femoral artery to be patent. The results justify the conclusion that dialysis via the Scribner shunt, u sing a standardized surgical technique, is a secure means of surgical vascular access, which is also effective for treatment of the underlyi ng disease and late vascular symptoms. Copyright (C) 1994 by W.B. Saun ders Company