Vascular access thrombosis in France: incidence and treatment patterns

Ann Vasc Surg. 2015 Aug;29(6):1203-10. doi: 10.1016/j.avsg.2015.02.008. Epub 2015 May 21.

Abstract

Background: Vascular access thrombosis lacks the implementation of a treatment algorithm at large scale, involving all the actors. We aimed to determine a better understanding of the current practice patterns around vascular access thrombosis in France, with 4 axes: incidence, surveillance protocol, treatment, and time to treatment.

Methods: A comprehensive survey of all the nephrologists staffing all hemodialysis centers in France during April 2013 included 266 of 269 (99%) centers, treating 27,798 patients with arteriovenous fistula or graft.

Results: In 104 centers treating 11,088 patients, there were 905 documented episodes of vascular access thrombosis (8.8%) in 1 year; in the other 162 centers that supplied a range of events, the mean incidence was 8.4%. Use of in-line access flow monitoring as part of surveillance program was not correlated with better outcome compared with Doppler ultrasound (thrombosis: 7.9% vs. 10%, respectively, P = 0.09). Fifty-three percent of centers referred the patients to a vascular surgeon and 32% to an interventional radiologist (2% to urologist and 13% variable referral depending on the case complexity). Time to treatment was <24 hr in 58% and <48 hr in 91% of the centers; treatment >48 hr (9%) occurred mainly in rural zones (P = 0.04). The specialty of the treating physician did not influence time to treatment (P > 0.05).

Conclusions: In France, vascular access thrombosis rate is low and not influenced by surveillance protocol type. Most patients can receive timely treatment by vascular surgeons or interventional radiologists.

MeSH terms

  • Arteriovenous Shunt, Surgical / adverse effects*
  • Attitude of Health Personnel
  • Blood Vessel Prosthesis Implantation / adverse effects*
  • France / epidemiology
  • Graft Occlusion, Vascular / diagnosis
  • Graft Occlusion, Vascular / epidemiology*
  • Graft Occlusion, Vascular / therapy
  • Health Care Surveys
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Incidence
  • Kidney Failure, Chronic / diagnosis
  • Kidney Failure, Chronic / epidemiology
  • Kidney Failure, Chronic / therapy*
  • Practice Patterns, Physicians'
  • Referral and Consultation
  • Renal Dialysis*
  • Surveys and Questionnaires
  • Thrombosis / diagnosis
  • Thrombosis / epidemiology*
  • Thrombosis / therapy
  • Time Factors
  • Time-to-Treatment
  • Treatment Outcome
  • Ultrasonography, Doppler