Who Treats Vascular Access Thrombosis and When? A Comprehensive Survey of All French Hemodialysis Centers

Abstract

Objectives: Vascular access thrombosis (VAT) is a severe complication that needs a timely treatment. The annual incidence of VAT and the timeliness of its treatment are not currently known. Methods: A comprehensive survey of all the nephrologists staffing all hemodialysis centers in France was performed during March and April 2013. The number of patients, percentage of permanent or temporary catheter use, incidence of VAT, specialty of the referral physician consulted to treat VAT, and mean time to treatment were recorded for each center. Data were compared between rural and urban zones of each center. Results: A total of 266 of 269 centers (99%) participated, with 114 private centers, 118 hospitals, and 37 academic hospitals treating 32,461 hemodialysis patients. A total of 27,798 patients (85%) used an arteriovenous (AV) fistula or graft, and 4663 (15%) required a permanent catheter. In 104 centers treating 11,088 patients with AV fistula or grafts, there were 905 documented episodes of VAT (8.2%) in 1 year; in the other 162 centers that supplied a range, the mean incidence of VAT was 8.5%. Immediately after diagnosis, 8% of the centers routinely placed a temporary catheter, and 26% never placed any catheter. Fifty-three percent of centers refer VAT to a vascular surgeon (VS) and 32% to an interventional radiologist (IR), with only 2% to urology and 13% variable referral depending on case complexity. There was a difference in referral patterns between rural (VS, 75%; IR, 25%) and urban centers (VS, 49%; IR, 51%). Time to treatment was 48 hours (9%) occurred predominantly in rural zones (P 1⁄4 .04). The specialty of the treating physician did not influence time to treatment (P > .05). Conclusion: The annual incidence of VAT is 8%, and 91% of cases in France are treated #48 hours, consistent with European treatment guidelines. There is a disparity between rural and urban centers regarding the specialty of the treating physician. Increasing access to VSs may be an alternative to regionalization of specialty care.