AI Article Synopsis

  • The incidence of chronic kidney disease (CKD) in children has increased over the past two decades, with arteriovenous fistulas (AVF) preferred for dialysis access, but maintaining them is often complicated by central venous occlusions caused by prior use of central venous devices.
  • A case study of a 10-year-old girl with end-stage renal failure demonstrated successful surgical intervention to address her venous occlusion by performing a bypass from the axillary vein to the external iliac vein, resolving her venous hypertension.
  • The report highlights that rising rates of central venous issues in pediatric patients necessitate innovative solutions, and emphasizes the importance of maintaining high flow in AVFs and using antiplatelet therapy post-surgery

Article Abstract

Introduction: During the past two decades, the incidence of chronic kidney disease (CKD) in children worldwide has steadily increased and, even in children, native arteriovenous fistula (AVF) remains the access of choice. Nevertheless, maintaining a well functioning fistula is limited by central venous occlusion due to the widespread use of central venous access devices before AVF creation.

Report: A 10 year old girl with end stage renal failure dialysing through a left brachiocephalic fistula presented with left upper limb and facial swelling. She had previously exhausted the option of ambulatory peritoneal dialysis for recurrent peritonitis. A central venogram showed occlusion at the left subclavian vein, which was not amenable for angioplasty through either an upper limb or femoral approach. Given the precious fistula with concomitant worsening venous hypertension, an ipsilateral axillary vein to external iliac vein bypass was performed. Subsequently, her venous hypertension was significantly resolved. This report is the first in English literature on this surgical bypass in a child with central venous occlusion.

Discussion: Central venous stenosis or occlusion rates are rising due to extensive central venous catheter use in the paediatric population with end stage renal failure. In this report, an ipsilateral axillary vein to external iliac vein bypass was used successfully as a safe temporary option to maintain AVF. Ensuring a high flow fistula pre-operatively and continued antiplatelet post-operatively will allow longer patency of the graft.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10310466PMC
http://dx.doi.org/10.1016/j.ejvsvf.2023.05.009DOI Listing

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