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[Vascular access and chronic renal failure]
A Oncevski1, P Dejanov, V Gerasimovska
1Centre hospitalier universitaire, clinique de néphrologie, Skopje, République de Macédoine.
Insights
Over nearly 25 years, Skopje hospital performed 8,849 vascular access procedures for dialysis, with a significant increase in preventive arteriovenous fistulas (AVFs) and a preference for femoral catheters for temporary access.
Area of Science:
- Nephrology
- Vascular Surgery
- Dialysis Access
Context:
- Analysis of 8,849 vascular access procedures performed between 1976 and 1999 at Skopje hospital.
- Focus on the types and trends of surgical interventions for hemodialysis access.
Purpose:
- To review the historical trends and methods of vascular access creation for dialysis.
- To identify preferred access types and changes in practice over a 23-year period.
Summary:
- Native arteriovenous fistulas (AVFs), arteriovenous shunts, and temporary/indwelling catheters were employed.
- Femoral vein catheterization was the predominant method for temporary dialysis access (90.50%).
- A notable increase in preventive AVFs was observed, rising from 14% in the 1980s to 31.50% in 1999.
Impact:
- Highlights the shift towards more permanent vascular access solutions like AVFs.
- Indicates the evolving strategies in managing dialysis vascular access in a specific clinical setting.
- Suggests the feasibility of performing a significant portion of these procedures in a day hospital setting.
Abstract:
From 1976 to 1999 a total of 8,849 surgical procedures for vascular access prior to dialysis were performed in the Department of nephrology at Skopje hospital (Macedonia). Cases included 3,114 native arteriovenous fistula (AVF), 715 arteriovenous shunts and 4,964 temporary or indwelling catheters (4,411 (88.86%) in the femoral vein, 410 (8.26%) in the subclavian vein, 143 (2.88%) in the jugular vein and 56 PTFE vascular grafts). Femoral catheterization is the favoured solution for repeated dialysis (90.50% of the 3,440 procedures for indwelling vascular access). Subcutaneous indwelling catheters were used in 270 (7.90%) cases, with vascular access taking place in either the femoral (99 cases), subclavian (123 cases) or jugular vein (48 cases). Biosynthetic vascular grafts represent only 1.6% of all procedures for vascular access. The number of preventive AVFs has been increasing steadily from 14% in the 1980s to 20.8% in the 1990s and 31.50% in 1999. The majority of preventive AVFs (71.80%) and a large number of other surgical procedures for vascular access (44.40%) are performed in day hospital.