A child receiving hemodialysis through a vibrant, glowing AVF.

AVF Lifeline: How Endovascular Interventions Are Revolutionizing Pediatric Hemodialysis

Avery Sinclair in Health & Wellness November 2025 • 4 min read.

"Discover how a pioneering 'endovascular-first' approach is transforming the maintenance and rescue of arteriovenous fistulas (AVFs) in children, offering a beacon of hope for those undergoing hemodialysis."

Arteriovenous fistulas (AVFs) are the gold standard for providing vascular access in children undergoing hemodialysis. Compared to central venous catheters (CVCs), AVFs offer superior clinical outcomes, including better dialysis quality, lower infection rates, and reduced hospitalizations. However, AVFs are not without their challenges. Stenosis (narrowing) and thrombosis (clotting) can compromise their functionality, requiring interventions to maintain patency and ensure effective long-term use.

Traditionally, managing AVF complications has involved a combination of endovascular (minimally invasive) and open surgical techniques. However, a growing body of evidence supports the use of an 'endovascular-first' approach, where minimally invasive interventions are prioritized to address AVF dysfunction. This approach aims to reduce the need for more invasive surgeries and preserve vascular access options for children who may require hemodialysis for extended periods.

A recent study published in Pediatric Nephrology sheds light on the efficacy of endovascular interventions in maintaining and rescuing pediatric AVFs. This research, led by Petrut Gogalniceanu and colleagues, presents a comprehensive analysis of endovascular procedures performed on children with AVF complications, offering valuable insights into optimizing vascular access management in this vulnerable population.

The 'Endovascular-First' Revolution: What Does It Mean for Pediatric Patients?

A child receiving hemodialysis through a vibrant, glowing AVF.

The 'endovascular-first' approach represents a paradigm shift in how vascular access complications are managed in pediatric hemodialysis. Instead of immediately resorting to open surgery, this strategy prioritizes minimally invasive techniques to address stenosis and thrombosis within the AVF. This approach offers several potential advantages for young patients:

Minimally invasive procedures, like angioplasty, typically involve smaller incisions, leading to less pain, reduced scarring, and faster recovery times. This is especially important for children who may require multiple interventions over the course of their treatment.

Preservation of Vascular Access: Endovascular interventions can help maintain the patency of the AVF, avoiding the need for CVCs. CVCs are associated with higher infection rates and can damage central veins, potentially limiting future vascular access options.
Reduced Hospitalizations: Minimally invasive procedures often allow for outpatient or short-stay hospital visits, minimizing disruption to the child's life and reducing healthcare costs.
Improved Dialysis Quality: By maintaining optimal AVF function, endovascular interventions can ensure adequate blood flow during hemodialysis, leading to more effective removal of waste products and improved overall dialysis quality.

The study by Gogalniceanu et al. highlights the effectiveness of this approach, demonstrating a high rate of immediate functional success (86%) with good dialysis adequacy at 3 months post-procedure. This suggests that endovascular interventions can be a reliable and effective means of maintaining AVF patency in children.

Empowering Future Care: The Importance of Vigilance and Innovation

The study underscores the importance of a proactive and vigilant approach to managing AVFs in pediatric patients. Regular monitoring through structured surveillance programs is crucial for early detection of potential problems. Furthermore, the development of emergency protocols and checklists can ensure timely access to endovascular intervention when needed. By embracing an 'endovascular-first' strategy and fostering ongoing innovation in vascular access management, healthcare professionals can empower children with kidney disease to lead healthier, more fulfilling lives.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1007/s00467-018-4143-8, Alternate LINK

Title: Endovascular Intervention In The Maintenance And Rescue Of Paediatric Arteriovenous Fistulae For Hemodialysis

Subject: Nephrology

Journal: Pediatric Nephrology

Publisher: Springer Science and Business Media LLC

Authors: Petrut Gogalniceanu, Sam Stuart, Narayan Karunanithy, Nicos Kessaris, Derek Roebuck, Francis Calder

Published: 2018-11-27

Everything You Need To Know

Why are arteriovenous fistulas (AVFs) considered the 'gold standard' for hemodialysis access in children?

Arteriovenous fistulas (AVFs) are favored for pediatric hemodialysis due to their superior clinical outcomes compared to central venous catheters (CVCs). AVFs provide better dialysis quality, lower infection rates, and reduced hospitalizations. While AVFs can experience complications like stenosis and thrombosis, their benefits generally outweigh these challenges, making them the preferred long-term vascular access option for children needing hemodialysis.

What does an 'endovascular-first' approach mean for managing arteriovenous fistula (AVF) complications in children?

The 'endovascular-first' approach prioritizes minimally invasive endovascular interventions, such as angioplasty, to address arteriovenous fistula (AVF) complications like stenosis or thrombosis before considering open surgical techniques. The goal is to maintain AVF patency, reduce the need for more invasive surgeries, and preserve vascular access options for children who may require hemodialysis for an extended duration. This strategy offers benefits like smaller incisions, reduced scarring, and faster recovery times.

How do endovascular interventions help improve the quality of life for pediatric hemodialysis patients?

Endovascular interventions, by maintaining optimal arteriovenous fistula (AVF) function, ensure adequate blood flow during hemodialysis. This leads to more effective removal of waste products, improving overall dialysis quality. Minimally invasive procedures associated with the 'endovascular-first' approach typically result in shorter hospital stays, minimizing disruption to the child's life and reducing healthcare costs. Avoiding the need for central venous catheters (CVCs) further improves quality of life, given CVCs higher infection rates and risks to central veins.

What are the key benefits of prioritizing an 'endovascular-first' strategy over traditional methods in pediatric AVF management?

The 'endovascular-first' strategy offers several key advantages. It prioritizes preservation of vascular access by maintaining arteriovenous fistula (AVF) patency and avoiding the need for central venous catheters (CVCs) which carry higher infection risks. Endovascular interventions typically involve minimally invasive procedures, resulting in reduced hospitalizations, less pain, and faster recovery times. By maintaining optimal AVF function, these interventions also ensure improved dialysis quality, leading to more effective waste removal. This proactive management approach empowers children with kidney disease to lead healthier lives.

What role do surveillance programs and emergency protocols play in optimizing outcomes for pediatric arteriovenous fistulas (AVFs)?

Surveillance programs are crucial for the early detection of potential problems with arteriovenous fistulas (AVFs), such as stenosis or thrombosis. Regular monitoring allows for timely intervention, preventing AVF failure and maintaining patency. Emergency protocols and checklists ensure quick access to endovascular intervention when needed, minimizing delays that could compromise vascular access. These proactive measures, combined with an 'endovascular-first' strategy, are vital for optimizing long-term outcomes and quality of life for pediatric hemodialysis patients.