Evaluation of Outcomes and Complications of Arteriovenous Fistulas for Haemodialysis Access in Paediatric Patients with Chronic Kidney Disease.

INTRODUCTION : Haemodialysis for long term became a possibility as a treatment option in chronic renal failure (CRF) in 1960 after Quinton and Scribner devised an external shunt that provided repetitive access to the circulation. The first arteriovenous (AV) access procedure was described by Brescia and Cimino in 1966.(1) Subsequently the development of various access techniques and devices occurred and today renal failure patients can survive on HD for decades. An ideal vascular access (VA) system should have the following features: 1. Reliable, repetitive access to the circulation, 2. Flow rates sufficient to deliver efficient dialysis, 3. Prolonged patency, 4. Low complication rate. However, no known method has been able to reach the ‘ideal’ situation. Haemodialysis access failure is today the commonest cause of hospitalization and is responsible for the highest number of hospitalised days for the patients on haemodialysis. Aims: Primary : 1. To calculate the primary patency rates of AVF/AVGs in children 2. To discover factors which may predict the patency. Secondary : To study the perioperative complication rate. CONCLUSIONS : An arteriovenous fistula is the optimal vascular access in children undergoing haemodialysis. With the Paediatric Fistula First Initiative, various centres worldwide have started using microsurgical techniques to create fistulas and use it as the primary vascular access with good results even in small children. The various advantages of using an AVF as the primary access in children includes its long life, low rate of complications and lower overall costs, albeit it has a higher primary failure rate than CVCs or AVGs. This study shows how even in resource-challenged countries, children with ESRD can be successfully managed on long term haemodialysis with AVF. These children tend to have less complications and hospitalizations compared to their counterparts who have CVCs for long durations. These results show that even in countries with limited resources, it is possible to reach and even surpass the KDOQI recommended target of 50% AVF use as primary access choice in children with ESRD. The communication between the surgeon, pediatric nephrologist and the dialysis technician/staff is integral in determining time to first use and proper cannulation technique to ensure adequate use for dialysis. We have confirmed what others have shown; that AVF can be successfully used in paediatric HD patients with careful diagnostic evaluation, optimal access site selection, meticulous microsurgical technique and multidisciplinary management of the access. Based on our results, we would advocate paediatric dialysis centres to work in collaboration with a vascular surgeon who is versed in these techniques to create a functioning AVF

An extremely rare case of an incidentally detected renal vein aneurysm and review of literature

Congenital renal vein aneurysms are a truncular type of venous malformation and are believed to be the outcome of defective development during the later stage of embryogenesis while the venous trunk is being formed. There have been 9 case reports so far. Here, we add the report of a patient who was incidentally detected to have a renal vein aneurysm on computed tomography angiogram. In addition, this is the first description of inferior vena cava thrombosis associated with a thrombosed saccular aneurysm of the renal vein