Vascular access for haemodialysis - experience at Johannesburg Hospital

Experience with angio-access in patients with chronic end-stage renal failure undergoing haemodialysis, including those with arteriovenous fistulas constructed within the past 3 years, is reviewed. In patients in group 1, 137 fistulas were constructed; the patency rate at 2 years was 66% and at 4 years 47%. Complications were due to thrombosis, aneurysm and poor operative technique. In group 2 fistulas were constructed from synthetic material in 33 patients; the patency rate at 2 years was 44% and at 4 years 36%. Complications were due to thrombosis and sepsis. No correlation was found between raised fibrinogen levels and fistula or graft failures. Dialysis needles of different gauges were compared; the 16-gauge Terumo needle was found to cause no hemolysis and was adequate for use in dialysis.