Analysis of vascular access in hemodialysis patients: a report from a dialysis unit in Casablanca.

Vascular access (VA) for patients needing maintenance hemodialysis (HD) remains a major obstacle in the management of patients with end-stage renal disease (ESRD). We retrospectively analyzed 190 patients, (92 males and 98 females) who had been on HD for a period ranging from 12 to 240 months. Their mean age was 42.8 years (range: 13 to 83 years). The study was carried out to analyze the VA, including the management of its complications. The cause of renal failure was chronic glomerulonephritis in 34.2% and unknown in 30.5% of the study cases. In 164 patients (86.3%), HD was initiated through a temporary catheter inserted in the internal jugular vein. Each patient had, on an average, two catheters inserted that lasted for a mean duration of 29 days. All patients had a native arteriovenous fistula (AVF) as the permanent VA. A primary radial-cephalic AVF was created in 96.3% of the patients. The median period before cannulation was 15 days. Failure of AVF function occurred in 18.4% of cases while the median survival of the primary AVF was 54.8 months. Thrombosis, seen in 26.4% of the patients, was the predominant complication, and this event seemed to be causally related to prior insertion of temporary catheters. Ten patients had arterio-venous grafts (AVG) placed due to recurrent thrombosis of the AVF. The AVG was brachial-cephalic in five patients. A tunneled cuffed catheter was placed in four patients who had no other possible access sites available. These catheters were placed in the right internal jugular vein in all of these patients. The success of VA in patients on HD requires a multi-disciplinary approach and early referral to a vascular surgeon.