Department of Vascular Surgery, Livingstone Tertiary Hospital; Walter Sisulu University, Port Elizabeth, South Africa. Email:
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.
Cardiovasc J Afr. 2021;32(2):98-101. doi: 10.5830/CVJA-2020-049. Epub 2020 Nov 11.
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.
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.
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.
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.
可靠的血管通路是可持续血液透析治疗的关键。指南建议首选动静脉瘘（AVF），而不是动静脉移植物（AVG）或中心静脉导管（CVC）。撒哈拉以南非洲地区关于血管通路的数据有限。本研究旨在评估南非一家三级医院的血管通路，并确定在实现推荐的血管通路目标方面存在的问题。
对利文斯顿三级医院的血液透析项目进行了横断面分析。记录当前和初始血管通路的使用、创建永久性通路的时间以及任何经历的并发症。
56%的患者使用 CVC，38%的患者使用 AVF，5%的患者使用 AVG。只有 12%的患者没有尝试过 AVF。绝大多数（95%）患者在开始透析时使用 CVC。预防性 AVF 建立的比例很低，63%的患者出现 AVF 建立延迟。26%的患者存在中心静脉狭窄或闭塞，可能是由于先前或当前的 CVC 使用所致。
CVC 的使用非常普遍，AVF 的建立存在明显延迟。较高的中心静脉狭窄率会影响未来的 AVF 使用，这可能是由于长期使用 CVC 所致。需要做出改变以改善血管通路服务，包括多学科的通路诊所、专门的手术室列表、血管通路协调员以及进一步收集数据以持续评估血管通路服务。
