Patency and Complication‑Free Survival of Hemodialysis Fistulas in a Sub‑Saharan African Cohort: A Retrospective Study of 162 Patients
Perméabilité et Survie sans Complication des Fistules d’Hémodialyse dans une Cohorte d’Afrique Subsaharienne : Une Étude Rétrospective de 162 Patients
DOI:
https://doi.org/10.5281/zenodo.19695303Keywords:
Outcomes, Arteriovenous fistula, hemodialysis, Sub-saharanAbstract
ABSTRACT
Introduction. Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis, yet outcomes in sub-Saharan Africa remain poorly reported. The current paper aimed to evaluate AVF patency and complication-free in a sub-Saharan African cohort. Patients and Methods. A retrospective cohort study including all the patients who underwent AVF creation between December 2024 and January 2026 was conducted. Early and late complications were assessed. Kaplan–Meier analysis was used to estimate primary patency and freedom from complications. Results. A total of 162 patients were selected. The mean age at surgery was 42 with a predominance of male gender (sex ratio: 1.2). The commonest cardiovascular risk factors were hypertension (69.1%) and diabetes (29.0%). Radiocephalic fistulas (RCF) were performed in 78% of patients whereas 22% of patients had brachiocephalic fistulas (BCF). No mortality was reported. Early complications included thrombosis (15%) and bleeding (8%). At 12 months, the overall freedom from restenosis was 68.5%. Radiocephalic fistulas had significantly lower patency compared with brachiocephalic fistulas (61.1% vs 94.4%, log-rank p=0.003). The overall freedom from complications (aneurysm infection, non-maturation) was 90.7% at 6 months and 83.3% at 12 months. No significant difference was observed between RCF and BCF groups (log-rank p=0.34) at follow-up. Conclusion. AVF creation is feasible in a Cameroonian tertiary center, but restenosis rates are substantial, especially for radiocephalic fistulas. Brachiocephalic fistulas offer better patency. Structural improvements in preoperative vessel assessment (ultrasound mapping) and postoperative surveillance are needed to optimize outcomes..
RESUME
Introduction. La fistule artérioveineuse (FAV) est la voie d'accès vasculaire privilégiée pour l'hémodialyse, mais les résultats en Afrique subsaharienne restent peu documentés. Le présent article avait pour objectif d'évaluer la perméabilité des FAV et l'absence de complications au sein d'une cohorte d'Afrique subsaharienne. Patients et méthodes. Une étude de cohorte rétrospective incluant tous les patients ayant subi la création d'une FAV entre décembre 2024 et janvier 2026 a été menée. Les complications précoces et tardives ont été évaluées. L'analyse de Kaplan-Meier a été utilisée pour estimer la perméabilité primaire et l'absence de complications. Résultats. Au total, 162 patients ont été sélectionnés. L'âge moyen au moment de l'intervention était de 42 ans , avec une prédominance masculine (rapport hommes/femmes : 1,2). Les facteurs de risque cardiovasculaire les plus fréquents étaient l'hypertension (69,1 %) et le diabète (29,0 %). Des fistules radio-céphaliques (RCF) ont été réalisées chez 78 % des patients, tandis que 22 % des patients ont bénéficié de fistules brachio-céphaliques (BCF). Aucun décès n’a été signalé. Les complications précoces comprenaient la thrombose (15 %) et les hémorragies (8 %). À 12 mois, le taux global d’absence de resténose était de 68,5 %. Les fistules radio-céphaliques présentaient une perméabilité significativement plus faible que les fistules brachio-céphaliques (61,1 % contre 94,4 %, p du test du log-rank = 0,003). L'absence globale de complications (infection de l'anévrisme, non-maturation) était de 90,7 % à 6 mois et de 83,3 % à 12 mois. Aucune différence significative n'a été observée entre les groupes RCF et BCF (log-rank p = 0,34) lors du suivi. Conclusion. La création de FAV est réalisable dans un centre tertiaire camerounais, mais les taux de resténose sont élevés, en particulier pour les fistules radio‑céphaliques. Les fistules brachio‑céphaliques offrent une meilleure perméabilité. Des améliorations structurelles (cartographie échographique préopératoire, surveillance postopératoire) sont nécessaires pour optimiser les résultats.
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Copyright (c) 2026 Charles Mve Mvondo, Zephanie Kobe Folkabo, Daniel Biwole Biwole, Lowe Kuissu Sepolin, Marcus Fokou, Arlette Géraldine Nguea Djame, Maimouna Mahamat, Laurence Carole Ngo Yon, Amos Ela Bella, Stephane Arroye Betou, Louis Richard Njock
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