Limb growth and cardiac complications of fistulas in children.

To assess the long term effects of arteriovenous (AV) fistulas placed in children for hemodialysis, we retrospectively evaluated 26 patients, ages 4 to 20 years, for: limb growth, evidence of excessive flow through the fistula, limb function and patient acceptance of the limb's appearance. The fistulas were created an average of 31 months prior to the study. Fourteen patients had wrist fistulas. Twelve patients had PTFE grafts; 5 in the upper thigh and 7 in the upper arm. Of the 5 patients with thigh PTFE fistulas, 3 developed ipsilateral limb hypertrophy, another developed cardiac failure and the other had excessive flow through the fistula without cardiac failure. One of the 7 children with an upper arm PTFE graft developed arm edema without hypertrophy. Two of the 14 children with wrist fistulas developed evidence of excessive flow through the fistula. Six of 26 patients (23%) required fistula ligation because of a complication.