Low-rate of complications after a long-term use of ateriovenous fistula (AVF) in hemophilic children

Background: Hemophilic children, undergoing regular prophylaxis or ITI, need a long-lasting uncomplicated venous access. Methods: Children lacking a venous access suitable for frequent infusions were eligible for AVF creation. AVF were accessed at home by parents. Doppler ultrasound of the limb and echocardiography were regularly performed. Results: Between 1999 and 2007, 43 AVF were created in 38 patients (FVIII/FIX <2%; median age 2.6 years, range: 0.9–11.9; 23 with inhibitors). AVF did not mature in 6 children (16%) and 5 of them underwent a second procedure that was successful in 4. Overall successful maturation was obtained in 36 AVF (84%) that were first accessed after a median of 56 days (21–135) and used for a median of 5.1 years (0.7–7.9) for ITI (20), prophylaxis (11) and on-demand treatment (5). Complications not preventing AVF use were: thrombosis of a venous branch (1. 3%) and transient distal ischaemia (4. 11%). Other complications were: aneurysmatic dilatation (4. 11%) observed after a median of 5.4 years (3.5–7.7), limb hypertrophy (1. 3%) after 5.4 years and AVF overflow (1. 3%) after 6.9 years. These complications were reason for surgical dismantlement and transition to peripheral veins after a median of 6.6 years (range: 3.5–7.1). Uncomplicated AVF were dismantled after 4–7.4 years in 2 children who developed adequate peripheral veins. Conclusions: AVF were satisfactorily safe in hemophilic children, allowing long-term home treatment in 36/38 (95%). Regular follow-up allows early remedial intervention in case of complications; however, transition to peripheral veins should be implemented as soon as possible