An Improved Arteriovenous Shunt for Pediatric Hemodialysis By Ferris S. Ray, Richard C. Dillihunt, and Robert E. McAfee
CCESS to the circulation for hemodialysis in children and infants is a ifficult technical problem because of the tenuous quality and small caliber of the vessels to be used. The successful application of the technique of Allen and Applegate ~ in children and infants has not been previously reported and seems worth doing, based on satisfactory results with four subjects under the age of 3 yr requiring hemodialysis for the hemolytic uremic syndrome for periods of from 1 to 4 wk. The procedure for creating an external arteriovenous shunt using a saphenous vein graft in the groin was performed under general anesthesia through a short transverse incision over the saphenous bulb. A 3-cm segment of saphenous vein was excised, reversed, and anastomosed to a linear incision in the c o m m o n femoral artery. Appropriately sized Teflon-tipped silastic catheters were sewn into the end of the vein graft and the other end sewn into the host saphenous vein below the bulb. At the time of shunt removal under local analgesia, the external catheter was followed through a small incision to the VEIN GRAFT-EXTERNAL A - V FISTULA
/ , ~ ~ v
B.
EIN GRAFT
/
,'~
9
C. ARTERY/~
FEMORAL~'~/~"
~IK@ ' "~
~
-
/
TEFLON-TIPSlLASTICSHUNT ~
VEIN _. . ~
"~\"
VEIN
E. COMPLETED ARTERIOVENOUSSHUNT VEINGRAFT
SUBCUTANOUSSUTURE
ZRTION OFTEFLON IPPEDSHUNTS "HROUGH JND
T-TUBECONNECTOR~
Fig. 1A. The saphenous vein graft is anastomosed to the side of the common femoral artery and the opposite end secured subcutaneously to the Teflon shunt. The latter courses externally then is secured to the distal saphenous vein proximal to the saphenous bulb.
From the Department of Surgery, Maine Medical Center, Portland, Me. Address for reprints: Ferris S. Ray, M.D., 7 Bramhall St., Portland, Me. 04102. 9 1976 by Grune & Stratton, Inc. Journal of Pediatric Surgery, Vol. 11, No. 6 (December),1976
1009
1010
RAY, DILLIHUNT, AND MC AFEE
vein graft leading to the artery, withdrawn, and the graft ligated. The venous outflow end was similarly treated. The technique avoided the necessity of closing the arteriotomy with possible compromise of the arterial lumen (Fig. 1A). Excellent flow was obtained in all cases with no shunt failures until removal 1-4 wk later. One complication of minor wound infection, not requiring shunt removal, occurred. REFERENCE
1. Allen LE, Applegate G: Arteriovenous shunts in the thigh for hemodialysis. J Urol 104:1970
CCESS to the circulation for hemodialysis in children and infants is a ifficult technical problem because of the tenuous quality and small caliber of the vessels to be used. The successful application of the technique of Allen and Applegate ~ in children and infants has not been previously reported and seems worth doing, based on satisfactory results with four subjects under the age of 3 yr requiring hemodialysis for the hemolytic uremic syndrome for periods of from 1 to 4 wk. The procedure for creating an external arteriovenous shunt using a saphenous vein graft in the groin was performed under general anesthesia through a short transverse incision over the saphenous bulb. A 3-cm segment of saphenous vein was excised, reversed, and anastomosed to a linear incision in the c o m m o n femoral artery. Appropriately sized Teflon-tipped silastic catheters were sewn into the end of the vein graft and the other end sewn into the host saphenous vein below the bulb. At the time of shunt removal under local analgesia, the external catheter was followed through a small incision to the VEIN GRAFT-EXTERNAL A - V FISTULA
/ , ~ ~ v
B.
EIN GRAFT
/
,'~
9
C. ARTERY/~
FEMORAL~'~/~"
~IK@ ' "~
~
-
/
TEFLON-TIPSlLASTICSHUNT ~
VEIN _. . ~
"~\"
VEIN
E. COMPLETED ARTERIOVENOUSSHUNT VEINGRAFT
SUBCUTANOUSSUTURE
ZRTION OFTEFLON IPPEDSHUNTS "HROUGH JND
T-TUBECONNECTOR~
Fig. 1A. The saphenous vein graft is anastomosed to the side of the common femoral artery and the opposite end secured subcutaneously to the Teflon shunt. The latter courses externally then is secured to the distal saphenous vein proximal to the saphenous bulb.
From the Department of Surgery, Maine Medical Center, Portland, Me. Address for reprints: Ferris S. Ray, M.D., 7 Bramhall St., Portland, Me. 04102. 9 1976 by Grune & Stratton, Inc. Journal of Pediatric Surgery, Vol. 11, No. 6 (December),1976
1009
1010
RAY, DILLIHUNT, AND MC AFEE
vein graft leading to the artery, withdrawn, and the graft ligated. The venous outflow end was similarly treated. The technique avoided the necessity of closing the arteriotomy with possible compromise of the arterial lumen (Fig. 1A). Excellent flow was obtained in all cases with no shunt failures until removal 1-4 wk later. One complication of minor wound infection, not requiring shunt removal, occurred. REFERENCE
1. Allen LE, Applegate G: Arteriovenous shunts in the thigh for hemodialysis. J Urol 104:1970
