MICROSURGERY IN GAINING PEDIATRIC VASCULAR ACCESS FOR HEMODIALYSIS

One hundred and one surgical procedures performed in children for cons truction and maintenance of vascular accesses for haemodialysis were r etrospectively analyzed. There were 86 operations performed to create a new fistula in patients without vascular access or with nonrecoverab le failed angio-access. Fifteen surgical procedures were performed to treat fistula complications. The new fistulas were radiocaphalic n = 6 0 (70%), ulnar-basilic n = 5 (5.8%), antecubital n = 9 (10.3%), and PT FE grafts n = 12 (14%). Microsurgical techniques were used in all case s, including PTFE graft fistulas. A microscope was used in 56 cases (5 5.4%) and magnifying loupes (x 2.5 magnification) in the rest of the o perations. Early-failure rate for radiocephalic fistulas was 10%. Cumu lative patency rates in radiocephalic fistulas were 79%, 75%, and 70% at 1, 2, and 5 years, respectively. No statistical differences were fo und from the cumulative patency curve of 730 radial-cephalic fistulas performed in adults during the same period of time. Radiocephalic fist ulas can be constructed in most paediatric cases using microsurgical t echnique. Elbow fistulas can be the vascular access, and PTFE grafts c an be reserved for children with exhaustion of autologous veins. Brach ial-jugular PTFE grafts can be used in cases of subclavian vein stenos is.