Barriers to primary prophylaxis in haemophilic children: the issue of the venous access.

摘要: Modern treatment for hemophilic children is based on prophylaxis and immune tolerance induction (ITI). Both regimens are frequent infusions at early ages, therefore an adequate venous access essential. Peripheral veins represent the best option, however, different solutions, as central devices (CVADs) arteriovenous fistulae (AVFs), can be adopted if needed. CVADs have been used in hemophiliacs, however their survival affected by infectious complications. Among CVADs, fully implantable usually preferred to external lines due a lower risk. The limited of may relevant impact outcome, especially case ITI where interruptions counterproductive. To overcome such drawbacks, internal AVF has considered alternative option owing rate Moreover, easy use home setting well accepted children. Possible complications not preventing postoperative hematoma transient symptoms distal ischemia; one symptomatic thrombosis reported so far. Long-term include loss patency, aneurysmatic dilatation and, rarely, limb dysmetria regular follow-up mandatory allow remedial intervention. Surgical dismantlement recommended soon transition peripheral possible.