Experience on the Vascular Approaches for Hemodialysis in the EL ABBADI Mohamed Saâd Clinic in Casablanca

The arteriovenous fistula (AVF) for hemodialysis, consists of surgically creating an anastomosis between an artery and a superficial vein in the arm. This study aims to mark our contribution to the study of arteriovenous fistulas for hemodialysis during our internship in Morocco Methodology: We carried out a six years retrospective study from January 1 st , 1994, to December 31 st , 1999, inclusively. The study involved 1,531 arteriovenous fistulas performed during our studying period on 2,361 consultations. All the adequate files were included in our study. The other inadequate files were excluded. Results: The study involved 833, that is 44.8% of men and 698, or 37.6% of women. Sex ratio 1.19. Thus, we counted right radial FAV 388 cases; Ulnar FAV 5 cases; FAV of the elbow crease 137 cases. In the left upper limb, 1,321 procedures, or 71.1%, distributed as follows: Left radial FAV 1,080 cases Cubital FAV 7 cases Elbow fold AVF 234 cases. According to the Vascular Seats (arteries and veins), the anastomoses were performed between Arteries and radial veins 388 or 20.9% Left radial arteries and veins 1080 cases or 58.1%, Humero-basilica 194 or 10.4%, Humero-cephalic 154 cases or 8.2%. Anastomoses on ulnar and other arteries 2, 5% straight 388 or 20.9% Left radial arteries and veins Conclusion: For patients with end-stage chronic kidney disease, arteriovenous fistulas are the last hope for their survival.


Introduction
The arteriovenous fistula (AVF) for hemodialysis, consists of surgically creating an anastomosis between an artery and a superficial vein in the arm [1,2].
The vein thus "arterialized" increases in size, its wall thickens, it becomes visible under the skin, and its puncture become easy.
In Switzerland, 2.2 million people suffer from a chronic condition, and almost 20% of the population aged> 50 suffer from multiple chronic diseases [3]. The material costs of noncommunicable diseases are very high. In 2011, they represented 80% of all direct health costs in Switzerland, that is, more than 51 billion francs [4][5][6][7]. As in other developed countries, chronic renal failure (CKD) is intimately linked to modern-day diseases [8,9]. Consequence, an increase in its prevalence, estimated at 1 to 20 people according to Dutch and American forecasts [10].
The arteriovenous fistula (AVF) constitutes the last hope of life for the patient on hemodialysis [11].
Seemingly easy to do but really difficult to keep, FAV remains the domain of a specialist surgeon, capable of all acrobatics to give life to a desperate patient, by creating a "venous" pathway sufficient for hemodialysis.
Unfortunately, the facts are cruel because no FAV can give the guarantee of being final.
They are then morally and physically fragile patients, who undergo multiple repetitions until the complete exhaustion of their venous capital [12].
The survival of the fistula depends on several factors of which we can cite among others: The quality of the vessels (arteries and veins) The etiology of renal failure systemic diseases. The quality of the anastomosis and that of the nursing staff [13].
Thus, the difficulties linked to the creation of fistulas and the fragile character of the patients are among other reasons the choice of this article.

Materials and Method
Our study was carried out in the office of Dr. EL ABBADI Mohamed Saâd, from Casablanca.
Our study materials consisted of patients admitted and operated for arteriovenous fistula for hemodialysis from 1994 to 1999 and pre-established survey sheets.
All the relevant files were included in the study.
No inadequate records were included in the study. We have carried out qualitative and quantitative analyzes of our medical records.
All our patients have been informed about the need to create fistulas in order to give them better hope of survival.
Administrative procedures and patient confidentiality were respected. We had encoded the patients.

Comments
From January 1 st , 1994, to December 31 st , 1999, 1,531 patients were hospitalized and operated in the EL ABBADI Mohamed Saâd Clinic in Casablanca for arteriovenous fistula for hemodialysis, an annual frequency of 129 patients.
The creation of the AVF for hemodialysis represents 75 percent of the activities of this clinic. Table 2.
The average age of the patients were 34 years with extremes of 9 years and 60 years. This confirms that terminal stage insufficiency can affect all age groups Table 2, our results agree with those of most publications (14.15.16.17.18).
The sex ratio of nearly 1.9 reflects a clear predominance of male affection.
This confirms that no FAV can give the guarantee to be final. The complications can be summarized by: nondevelopment, stenosis, Thrombosis, ischemia, aneurysm, infection and/or hyper flow. These fairly frequent complications, resulting in rather delicate situations for patients who think that an act must necessarily correspond to a satisfactory result; and for the Doctor who, to satisfy the patient, is sometimes obliged to spend out of his pocket to correct a complication, however independent of the act.
Note: the rise in the consultation curve and that of the firm's specialization in the creation of the FAV (table 1). All ages are affected by acute or chronic diseases causing kidney failure and, therefore, hemodialysis.
The most affected age group is that of 60 years and over (48.8%).
The preference of the left upper limb is an indication of hemodialysis for patient convenience.
We can thus safely predict that the black series of this lady will continue until the complete exhaustion of all her venous capital.
Note that we voluntarily omitted the previous acts relating to the radial FAV and the catheter poses suffered by this patient. And her only hope remains her Doctor.
The left upper limb is much more used than its right counterpart (3 times out of 4).

Conclusion
The arteriovenous fistula constitutes the last hope of life for the patient on hemodialysis. This is how important it is to spare this fistula, the creation of which is the responsibility of a specialist surgeon with suitable instrumentation, therefore expensive for the patient and the structure that supports him, because of the fairly frequent complications.
Healthcare workers must, therefore, respect an arterialized vein, always keeping in mind that the patient's venous capital is most important.