Creating arteriovenous fistulas for children in Guatemala.

Objective: The Guatemalan Foundation for Children with Kidney Diseases was established in 2003 as the first and only comprehensive pediatric nephrology program and hemodialysis unit in Guatemala. Bridge of Life (BOL) is a not-for-profit charitable organization focused on chronic kidney disease and supplied equipment, training and support during formation of the hemodialysis unit. Pediatric permanent vascular access (VA) expertise had not been established and noncuffed dialysis catheters provided almost all VA, many through subclavian vein access sites.

Outcomes with arteriovenous fistulas in a pediatric population.

Objective: Kidney Disease Outcome Quality Initiative guidelines recommend permanent access in dialysis patients aged 0 to 19 years who weigh >20 kg and are unlikely to receive a transplant within 1 year. Unfortunately, >80% of these patients currently receive dialysis through a permanent catheter and are exposed to the associated risks and shortcomings. With a clear imperative to increase the incident use of permanent access in pediatric patients, our objective was to examine the long-term outcomes of pediatric arteriovenous fistulas (AVFs).

Endovenous saphenous vein ablation in patients with acute isolated superficial-vein thrombosis.

Objective: The possible benefits of endovenous saphenous ablation (EVSA) as initial treatment in patients presenting with isolated superficial-vein thrombosis (SVT) and saphenous vein reflux include: (1) definitive treatment of the underlying pathology and (2) elimination of the saphenous vein as a path for pulmonary emboli, which (3) may eliminate the need for anticoagulation.

Methods: In a ten-year review of 115 limbs presenting with acute isolated SVT, 72 limbs (71 patients) with saphenous reflux were given a choice of two treatments following an explanation of the risks and benefits of each. Group I limbs (n = 41) were treated with office EVSA using radiofrequency or laser with or without thrombophlebectomy if performed within 45 days of diagnosis.

Adjunctive proximal vein ligation with endovenous obliteration of great saphenous vein reflux: does it have clinical value?

The risk of clot extension to the deep venous system or pulmonary embolism following endovenous great saphenous vein (GSV) obliteration is possibly related to the size of the proximal GSV. Some practitioners therefore exclude endovenous GSV obliteration for veins greater than an arbitrary size, starting as little as 15 mm. Others provide adjunctive proximal GSV ligation either routinely, or in selected patients with large veins.