ARTERIOVENOUS FISTULA (AVF) IS A SAFE AND SUITABLE VENOUS ACCESS FOR IMMUNE TOLERANCE TREATMENT (ITT) IN HEMOPHILIC CHILDREN
Abstract number: O-S-061
Santagostino1 E., Mancuso1 M.E., Siboni1 S.M., Mannucci1 P.M.
1Department of Internal Medicine and Medical Specialities, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, IRCCS Maggiore Hospital Foundation, Milan, Italy
How-to-cite Santagostino E, Mancuso ME, Siboni SM, Mannucci PM. ARTERIOVENOUS FISTULA (AVF) IS A SAFE AND SUITABLE VENOUS ACCESS FOR IMMUNE TOLERANCE TREATMENT (ITT) IN HEMOPHILIC CHILDREN. J Thromb Haemost 2007; 5 Supplement 2: O-S-061
Introduction: Since the use of ports in hemophiliacs is associated with a high risk of infection, proximal AVFs were investigated.
Methods: Between 1999 and 2005, 35 patients with FVIII/FIX <2% (median age 2.7 years, 0.9-12.0) required AVF creation after port removal (10) or as first option (25) to allow ITT (23) or prophylaxis (12). Eleven children came from other Centres while 24 (26%) were from our cohort of 92 with the same features. AVFs were accessed at home and followed-up with Doppler ultrasound of the limb and echocardiography.
Results: Inadequate AVF maturation was observed in 6 children, 5 underwent a second procedure that was successful in 4. Successful maturation was obtained in 33/40 AVFs (82%) used by 33 patients (94%). AVFs were first accessed after a median of 57 days (21-135) and used for a median of 4.8 years (0.9-7.2). Complications not preventing AVF use were: thrombosis of a venous branch (1/33, 3%) and transient distal ischaemia (3/33, 9%). AVF was remodelled in a child (3%) who showed limb hypertrophy after 5 years. AVF failed to maintain blood flow in a child (3%) after 4 years of use. Reasons for AVF dismantlement were: aneurysmatic dilatation (1, 3%) and transition to peripheral veins (1, 3%) after 5 and 4 years of use, respectively. Thirty AVFs are still used. ITT was completed using AVFs in 20 patients and was not started in 3 for reasons other than the venous access.
Conclusions: A low rate of complications makes AVFs safe and suitable for children, especially on ITT. Regular follow-up allows early remedial intervention. Transition to peripheral veins should be implemented as soon as possible.
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Journal of Thrombosis and Haemostasis 2007; Volume 5, Supplement 2: abstract number
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