COMPLICATIONS DES FISTULES ARTERIO-VEINEUSES POUR HEMODIALYSE CHRONIQUE AU SENEGAL: A PROPOS DE 354 CAS

Abstract

Summary Introduction: Chronic kidney disease (CKD) is a major public health problem. In sub-Saharan Africa its prevalence was estimated at 13.9% in 2014. Despite an increase in the number of kidney transplants, which is the best treatment for patients with CKD, chronic hemodialysis is still the most used treatment. Implementation of a hemodialysis treatment requires a vascular approach whose native arteriovenous fistula (AVF) provides the best access because of its low complication rate, its long-term use and its lower costs, compared to the graft arteriovenous and central venous catheter. Aims: This study was conducted to clarify: the different techniques for creating these arteriovenous fistulas for hemodialysis used in a context of a sub-Saharan African country, to report and analyze the various complications that pose a real problem for the sustainability of these AVFs and to specify the nature of their care in a sub-Saharan country such as the Senegal. Materials and methods: This was a monocentric retrospective, descriptive and analytical study of patients who had benefited from the support for a AVF complication during the 06-year period from January 2012 to December 2017 at FANN in Thoracic and Cardiovascular Department. Results: The number of cases included in the study was 354 cases of complications recorded on 280 AVFs in 200 patients with chronic renal failure or 1.4 AVFs complicated per patient. There was a female predominance with a sex ratio of 0.81. The average age of our patients was 46.95 years (11-87). Nephroangiosclerosis was the leading cause of chronic renal failure in our series (16.5%). One hundred and sixty-six of our patients were already on dialysis, including 161 on hemodialysis and 5 on peritoneal dialysis. Most of the complicated AVFs in our study were native (99.29%). Only 2 complicated AVFs were prosthetic (0.71%). The average lifespan of AVFs in our study was 3.7 months (0-73). Among the complications identified, early thrombosis was 52.1%, hemorrhage 24.6%, early infections 7.9%, late maturation 4.3 %, late thrombosis at 21.4%, aneurysms at 8.2%, false aneurysms at 5.7%, late infections at 3.9% and hight flow at 0.7%. Keywords : Arteriovenous fistulas, Complications, Senegal