Since 1967, a total of 64 patients have been treated at the Childrens Hospital of Los Angeles by hemodialysis for renal failure. The use of carefully sized intraluminal Scribner shunt tubes, Thomas shunts with end-to-side anastomoses, and subcutaneous vein graft arteriovenous (AV) fistulas all have decreased the need for surgical revision. In those patients requiring revisions, even multiple ligations of a major artery of one extremity have not produced distal vascular insufficiency. A practical approach to the selection of the shunt site and type is the use of a Scribner shunt in the forearm of a child 10 years of age or older if the length of dialysis period will not be longer than eight weeks. When a long-term dialysis is expected, a saphenous vein graft AV fistula below the elbow is preferred. In the smaller children a Scribner shunt in the arm with use of a brachial artery or a Thomas shunt in a lower extremity are preferred.
Franzone AJ, Tucker BL, Brennan LP, Fine RN, Stiles QR. Hemodialysis in Children: Experience With Arteriovenous Shunts. Arch Surg. 1971;102(6):592–593. doi:10.1001/archsurg.1971.01350060056016
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