Long-term safety and feasibility of arteriovenous fistulae as vascular accesses in children with haemophilia: A prospective study

Elena Santagostino, Alessandro Gringeri, Luisa Berardinelli, Claudio Beretta, Myrvet Muça-Perja, Pier Mannuccio Mannucci

Research output: Contribution to journalArticlepeer-review

Abstract

Infectious and thrombotic complications limit the long-term use of subcutaneous ports as venous accesses for children with haemophilia. This study has evaluated for the first time the safety and feasibility of internal arteriovenous fistulae (AVF) as alternative accesses. During the 3-year study period, 27 severe haemophiliacs, 14 with factor VIII inhibitors (52%), underwent the creation of 31 proximal AVF in the forearm. Mild forearm haematomas were observed after five procedures (16%) in five patients who had or developed inhibitors after surgery. Inadequate AVF maturation was observed after five of 31 procedures (16%) in four children. AVF were first accessed after a median of 42 d and regularly used at home by 26 patients (96%) for a median follow-up period of 29 months. Thrombosis of a venous branch occurred in one AVF (3%) after 9 months of uncomplicated use in a child with inhibitor who spontaneously recovered from the symptoms and still used AVF for nine additional months. Mild symptoms, referable to distal ischaemia, were transiently reported by two children (7%) who needed no remedial intervention. This study demonstrates that the use of AVF in haemophiliacs enabled long-term treatment at home in all patients but one.

Original languageEnglish
Pages (from-to)502-506
Number of pages5
JournalBritish Journal of Haematology
Volume123
Issue number3
DOIs
Publication statusPublished - Nov 2003

Keywords

  • Haemophilia
  • Immune tolerance
  • Inhibitors
  • Prophylaxis
  • Venous access

ASJC Scopus subject areas

  • Hematology

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