[Chronology of vascular access in hemodialysis. Apropos of 244 accesses in 150 hemodialysis patients].

Out of an experience of 244 vascular access in 150 patients the authors try do find the best chronology of the angioaccess procedures. 68% of the patients see their need in vascular access definitely resolved by the first classical forearm internal arterio-venous fistula and everything must be done in the dialysis population to avoid the failure of the fistula. This would lead to internal shunt procedures using graft materials of which we know the limited potency, leading to periodic operations. Emergency situations are approached by use of the femoral vein catheterization for hemodialysis. Only the impossibility of femoral or jugular catheterization would lead to the use of the external A.V. Shunt which would be placed on the leg to preserve the vessels of the arms. For some patients the repeated failure of the successive A.V. fistula and shunts have drived us towards either peritoneal dialysis or "hemasite" vascular access system.