Mohamed Ameur Frih
University hospital center Fattouma Bourguiba MONASTIR TUNISIA.
Title: COMPLICATIONS OF PERMANENT VASCULAR ACCESS IN HEMODIALYSIS ABOUT 1299 VASCULAR ACCESS
Biography
Biography: Mohamed Ameur Frih
Abstract
Introduction: End-stage chronic kidney disease is a worldwide public health problem which implies several health providers. Waiting for a kidney transplant, permanent vascular access remains the best alternative for hemodialysis.
Aim of the work: The aim of our study was to analyze the most important complications of vascular access for hemodialysis and to compare the study results with those of a similar study (old study) conducted in the same department for an 18-year-period (between 1981 and 1998).
Methods: We conducted a retrospective study of 1299 permanent vascular access created in 913 patients in the Nephrology Department CHU Fattouma Bourguiba Monastir, between 2000 and 2009.
Results: The mean age of patients was 53.96 years. Those aged over 60 accounted for 39%. Our population included 383 women and 530 men (sex ratio = 1.37). In our patients 36.6% were diabetic, 65.9% were hypertensive and 11.4% dyslipidemia. The glomerular origin of nephropathy was the most frequent with 51.8%. The majority of our patients were dialized three times a week. The distal fistulas were most common with a frequency of 70.05% among the different locations and types of AVF. The incidence of early failures was 4.39%. Late thrombosis interested 10.03% of all fistulas.
Discussion: about native fistulas and from the old study, we noticed an increase in early failures (4.4% versus 3.1%) and late aneurysms (4.5% versus 1.5%) while there is decrease in late infections (1.8% against 3%) and late stenosis (1.3% against 2.2%). For synthetic grafts, we remarked a reduction in early failures (4% versus 14%) and late thrombosis (8.3% versus 33.3%) while there is an increase in early thrombosis (12.5% against 4.7%), the early infections (4% against 0%) and late infections (20.8% against 14.3%).
Conclusion: Complications of fistulas surgically created have serious medical and socioeconomical consequences. Our study highlights the importance of regular supervision of the vascular access to detect complications early and we recommended to have training routines for professionals of dialysis in the handling of fistulas in order to maximise the efficiency and safety of a renal patient’s arteriovenous fistula.