Outcomes of Extra-Anatomic Surgical Bypass in Treatment of Central Venous Occlusive Disease in Pediatric Chronic Hemodialysis Patients: One-Year Follow-Up | ||||
| The Egyptian Journal of Surgery | ||||
| Volume 44, Issue 2, April 2025, Page 695-699 PDF (547.92 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/ejsur.2024.332771.1258 | ||||
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| Authors | ||||
Moustafa Mahmoud ElKenawy  ; Tarek Ahmed Adel AbdelAzim; Mohamed Emam Fakhr
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| Department of Vascular Surgery, Faculty of Medicine, Ain Shams University, Egypt | ||||
| Abstract | ||||
| Background: For children with end-stage renal disease, maintaining the patency of the hemodialysis vascular access is still crucial. Arteriovenous access is significantly hampered by venous hypertension caused by central venous occlusive disease (CVOD). CVOD is managed with limited data regarding the role of endovascular intervention in pediatrics, surgical bypass is a salvage technique for the dialysis access, resulting in prolonged patency and satisfactory outcomes. Objectives: Our prospective, observational study is to assess the effectiveness and results of surgically treating juvenile patients with CVOD associated with hemodialysis. Patients and Methods: 15 pediatric patients with end-stage renal disease and CVOD receiving hemodialysis via upper extremity access received extra-anatomic surgical bypass. The study started from June 2021 until May 2022. Patients included in the study were attending the Vascular Outpatient Clinic at Ain Shams University Hospitals and Nasser Institute at Cairo. Results: Axillary to Rt Subclavian bypass 3 (20%) and Lt Subclavian to Rt Subclavian bypass 3 (20%) are the most commonly used bypass configurations. Rt Axillary to Lt Subclavian bypass 2 (13.33%), Rt Cephalic to Lt Subclavian bypass 2 (13.33%), and Rt Axillary to Rt femoral bypass 2 (13.33%). The other bypasses: Lt Cephalic to Rt Subclavian, Rt Subclavian to Lt Subclavian and Lt Axillary to Lt Femoral are (6.66%). Within 48 hours, patients completed 4-hour hemodialysis sessions using previous access; 15 instances (100%) had technical success, while 13 cases (86.6%) had functional success. There were no documented in-hospital deaths or morbidities. At one, three, six, and twelve months, the primary patency rates were 93.3, 86.6, 66.6, and 46.6%, respectively and the secondary patency rates were 100%, 93.3%, 73.3%, and 53.3%, respectively. Conclusion: Extra-anatomic surgical bypass is an effective method for management of CVOD in hemodialysis pediatric patients providing symptomatic relief of venous hypertension, prolonged patency, and satisfactory outcome. | ||||
| Keywords | ||||
| Central venous occlusion; pediatric hemodialysis; venous hypertension | ||||
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