Objective:
Treatment of bleeding disorders consists of factor replacement on-demand in response to acute bleeding or prophylactically to prevent bleeding. Venous access is a critical aspect of hemophilia care. Placement of Arteriovenous Fistulae (AVF) has previously been reported (Urgo, J et al 2008). We are reporting the long-term use of the AVF and an additional 3 patients.
Methods:
All patients who received an AVF had their records reviewed and they were evaluated for their AVF usage patterns, perceived appearance, longevity of use, and overall satisfaction. The insertion protocol has been previously reported. Each patient’s AVF was assessed routinely at each clinic visit.
Summary:
There were 17 AVF insertions in 16 patients: two von Willebrand disease, 12 Hemophilia A (3 inhibitor), and 3 Hemophilia B (1 inhibitor). Mean follow-up was 5 years (1- 13 years). 15 patients had excellent results with adequate flow and patients/caregivers were able to easily access the AVF for treatment. 1 patient, who underwent 2 procedures, had a poor surgical result with inadequate blood flow to the AVF. No patients had bleeding complications from AVF creation. No patients have an AVF related infection over 5 years. Patients have not experienced any difficulty accessing the AVF for administration of factor. Four patients have reported dissatisfaction with the appearance of the AVF. All report embarrassment over appearance, self-consciousness, wear clothing to hide the AVF, and limited participation in activities where others may question the AVF. All report the AVF works well, no issues with access, and increased confidence in self-infusion. These patients all had enlarged AVF with increased blood flow as demonstrated by fistulogram. 1 patient had revision with banding that had excellent results as well as improved appearance and continued excellent intravenous (IV) access. Two more patients are scheduled for revision. The 4th patient had removal of the AVF due to increased availability of peripheral access.
Conclusion:
AVF continues to be a viable option in patients who do not have IV access and have had repeated complications with other methods of IV access. The complication rate for insertion is 3/17 (18%). Excellent IV access was achieved in 15/16 (94%) patients. Overall satisfaction is good with 9/13 (69%) patients reporting excellent function, ease of access, and satisfaction of the cosmetic appearance of the AVF.