Objectives To obtain baseline data for further research we summarized the use of arteriovenous fistula for blood access in pediatric maintenance hemodialysis patients. Methods We retrospectively reviewed the clinical data of 62 pediatric patients with autologous arteriovenous fistula for maintenance hemodialysis
during the period from June 2007 to April 2014 in the Department of Nephrology, Beijing Children’s Hospital. Results ①in the 62 cases, 41 were males and 21 were females with the age of 5～9 years old in 9 cases, 9～13 years old in 33 cases, and 13～17 years old in 20 cases. The average age at surgery was 13 years and 5 months (5y8m to 16y2m). The primarily resident place was southern China in 4.8% cases and northern China in 95.2% cases. The primary disease was chronic glomerulonephritis in 29.03% cases, and kidney abnormality or dysplasia in 27.40% cases. ②The average interval from diagnosis of chronic renal disease to arteriovenous fistula surgery was 30.8 days. ③ Anesthesia modalities: general anesthesia in 42 cases, and brachial plexus block in 17 cases. ④Side selection: left side in 58 cases, and right side in 4 cases. All patients were subjected to forearm arteriovenous fistula surgery, in which radio- cephalic end- to- lateral anastomosis was performed in 55 cases and radio-noncephalic anatomosis in 7 cases. ⑤Inner diameter of the fistula at surgery: 2mm in 22 cases (35.5%), 2.5mm in 3 cases (4.8%), 3mm in 31 cases (50%), 4mm in 3 cases (4.8%), and size unknown in 3 cases. ⑥The presence of tremor and vascular bruit at the operation site after surgery for one week was regarded as surgery success. Fistula was established in 50 cases (80.65%), and was failed to establish
in 12 cases (19.35%). The success rate to establish a fistula was 81.8% (18/22) in patients with fistula in-ner diameter of 2mm, and was 86.5% (32/37) in those with the diameter of >2mm, without significant difference between the two groups. The success rate of the second surgery was 87.5%. ⑦The tremor at the operation site after the surgery was relatively strong in 52 case (83.9%), weak in 3 cases (4.8%), and none in 7 cases (11.3%). The vascular bruit was relatively intense in 53 cases (85.5%), slight in 2 cases (3.2%), and none in 7 cases (11.3%). ⑧Complications immediately after surgery: thrombosis in 6 cases (9.7%), errhysis in 5 cases (8.0%), swollen and pain in 4 cases (6.5%), hemorrhage in one case (1.6%), and finger numbness in one case (1.6%). ⑨Arteriovenous fistula was used at the first hemodialysis session in only one case (1.6%). Conclusion The time interval from diagnosis of chronic renal disease to fistula surgery was 30.8 day, much shorter than 6～12 months suggested by the vascular access guideline in 2006 NKF-KDOQI. We preferred to make ratio- cephlic end- to- lateral anastomosis in left wrist. Success rate of the operation was 80.65% (50 cases), which was unrelated to the inner diameter of fistula orifice. The most common acute complications in this series of patients were thrombosis and errhysis.