Ian R Grant1, Robert J Freercks2, Eduard J Honiball3, Bhekifa Dube3. 1. Department of Vascular Surgery, Livingstone Tertiary Hospital; Walter Sisulu University, Port Elizabeth, South Africa. Email: ianroygrant@gmail.com. 2. Division Nephrology, Department of Medicine, Livingstone Tertiary Hospital, Port Elizabeth; Division Nephrology and Hypertension, Department of Medicine, University of Cape Town, Cape Town, South Africa. 3. Department of Vascular Surgery, Livingstone Tertiary Hospital; Walter Sisulu University, Port Elizabeth, South Africa.
Abstract
BACKGROUND: Reliable vascular access is key to sustainable haemodialysis treatment. Guidelines recommend an arteriovenous fistula (AVF) as the preferred modality in preference to arteriovenous grafts (AVGs) or central venous catheters (CVCs). There are limited data on vascular access in sub-Saharan Africa. This study aimed to evaluate the vascular access used in a South African tertiary hospital and identify problems with achieving the recommended access goals. METHODS: A cross-sectional analysis was performed of the haemodialysis programme at Livingstone Tertiary Hospital. Current and initial vascular access used, timing until the creation of permanent access, and any complications experienced were recorded. RESULTS: CVCs were used in 56% of subjects, 38% were using an AVF and 5% were using an AVG. Only 12% of the group had no AVF attempt. The overwhelming majority (95%) had dialysis initiated with a CVC. The rate of pre-emptive AVF creation was low and a delay in AVF creation was seen in 63% of patients. Central venous stenosis or occlusion was present in 26% of patients and likely due to prior or current CVC use. CONCLUSIONS: The prevalence of CVC use was high and there were significant delays to AVF creation. High rates of central venous stenosis compromise future AVF use and are likely due to prolonged CVC use. Changes needed to improve the vascular access service include a multidisciplinary access clinic, dedicated theatre list, vascular access co-ordinator and further data collection to continually evaluate the vascular access service.
BACKGROUND: Reliable vascular access is key to sustainable haemodialysis treatment. Guidelines recommend an arteriovenous fistula (AVF) as the preferred modality in preference to arteriovenous grafts (AVGs) or central venous catheters (CVCs). There are limited data on vascular access in sub-Saharan Africa. This study aimed to evaluate the vascular access used in a South African tertiary hospital and identify problems with achieving the recommended access goals. METHODS: A cross-sectional analysis was performed of the haemodialysis programme at Livingstone Tertiary Hospital. Current and initial vascular access used, timing until the creation of permanent access, and any complications experienced were recorded. RESULTS: CVCs were used in 56% of subjects, 38% were using an AVF and 5% were using an AVG. Only 12% of the group had no AVF attempt. The overwhelming majority (95%) had dialysis initiated with a CVC. The rate of pre-emptive AVF creation was low and a delay in AVF creation was seen in 63% of patients. Central venous stenosis or occlusion was present in 26% of patients and likely due to prior or current CVC use. CONCLUSIONS: The prevalence of CVC use was high and there were significant delays to AVF creation. High rates of central venous stenosis compromise future AVF use and are likely due to prolonged CVC use. Changes needed to improve the vascular access service include a multidisciplinary access clinic, dedicated theatre list, vascular access co-ordinator and further data collection to continually evaluate the vascular access service.
Authors: Gamal Mustafa Ahmed; Mustafa Omran Mansour; Mohamed Elfatih; Khalid Eltahir Khalid; Mohammed El Imam Mohammed Ahmed Journal: Saudi J Kidney Dis Transpl Date: 2012-01
Authors: Jürg Schmidli; Matthias K Widmer; Carlo Basile; Gianmarco de Donato; Maurizio Gallieni; Christopher P Gibbons; Patrick Haage; George Hamilton; Ulf Hedin; Lars Kamper; Miltos K Lazarides; Ben Lindsey; Gaspar Mestres; Marisa Pegoraro; Joy Roy; Carlo Setacci; David Shemesh; Jan H M Tordoir; Magda van Loon; Philippe Kolh; Gert J de Borst; Nabil Chakfe; Sebastian Debus; Rob Hinchliffe; Stavros Kakkos; Igor Koncar; Jes Lindholt; Ross Naylor; Melina Vega de Ceniga; Frank Vermassen; Fabio Verzini; Markus Mohaupt; Jean-Baptiste Ricco; Ramon Roca-Tey Journal: Eur J Vasc Endovasc Surg Date: 2018-05-02 Impact factor: 7.069
Authors: M Razeen Davids; John B Eastwood; Neville H Selwood; Fatiu A Arogundade; Gloria Ashuntantang; Mohammed Benghanem Gharbi; Faiçal Jarraya; Iain A M MacPhee; Mignon McCulloch; Jacob Plange-Rhule; Charles R Swanepoel; Dwomoa Adu Journal: Clin Kidney J Date: 2015-11-25