Introduction: We describe a pathology that is poorly known in our practice, vascular stenosis syndrome related to arteriovenous fistula (AVF). The goal is to contribute to the improvement of its ...care.Observations: This 60-year-old patient has been a diabetic type 2 patient for 12 years and been treated with insulin twice a day. She has been hypertensive for two years and has been treated with amlodipine 10 mg/l per day. She has been on haemodialysis since January 2018, carrying an arteriovenous fistula of the left arm created in Morocco in February 2018, i.e. one month after the start of haemodialysis. She received haemodialysis in four different centres, did three sessions per week of four hours then three hours because of unilateral arm cramps, homolateral to AVF from the third hour associated with acroparesthesia. The arm was of normal colour, isothermal temperature to the contralateral arm without trophic disorders, the whole evolving since three months. The residual diuresis was 1000 ml per 24 hours. In front of these diffuse bilateral acroparesthesies in gloves on the left arm and homolateral to FAV at six months of HD in four different centres we thought about: AVF-related vascular steal syndrome; carpal tunnel syndrome in chronic renal failure (CRF) in HD and amyloid arthropathy of the HD arm. Amyloid arthropathy: bilateral involvement, old haemodialysis more than ten years. Carpal tunnel syndrome: acroparesthesia on the arm, the ENMG showed axon-dependent lengthwise sensitivomotor polyneuropathy consistent with metabolic origin (renal failure and diabetes). AVF vascular steal syndrome was associated with signs of arterial tissue ischaemia on diabetic axonal sensitivomotor polyneuropathy. Biological results: Ferritinemia: 816,9 ng/ml. Normal. Glycaemia before HD: 2.25 g / l HbA1C: 8%. Diabetes mellitus type 2 imbalanced. Hb: 9.1 g/dl; VGM: 84.3u3; MCHC: 33 g/dl. Normochromic normochromic anaemia. The result of the echodoppler of AVF: hyperdebit of the assembly with varicose dilatation of the venous segment downstream. There are resistive types on the ulnar and radial arteries. Treatment at the end of hemodialysis: 1 ampoule of vitamin B, EPO alpha 2000 IU subcutaneously twice a week. The treatment except hemodialysis: Aspégic 100 mg 1 bag per day, Mixtard 8ui morning and evening 8ui.The vascular surgeon proposed the ligature of AVF or the dimunition of its caliber.
Background: Due to their immunosuppression to varying degrees and significant comorbidity, patients on chronic dialysis have an increased risk of developing severe acute respiratory syndrome 2 ...(SARS-CoV-2) at Covid 19. We wanted to describe the incidence, risk factors and outcomes of Covid 19 infection in these patients in Brazzaville. Patients and methods: The study was carried out in a private hemodialysis center in Brazzaville (Congo). The data was collected retrospectively. Included were chronic hemodialysis patients who tested positive for Covid-19 between April 1, 2020 and November 30, 2021. We assessed disease characteristics, mortality, risk factors for infection and mortality from multivariate logistic regression analyses. Results: During the study period, 14 out of 46 hemodialysis patients (30.4%) were diagnosed with Covid-19 infection. Their average age was 42.3 ± 8.7 years with a male predominance (sex-ratio = 2.5). Among them, 13 (92.8%) presented with respiratory distress requiring hospitalization and the mortality rate was 42.8% only one was vaccinated against covid-19 (Vaccine from the Johnson Johnson laboratory). Significant predictors associated with infection included HIV (OR= 12.4 95% CI 17.1–43.7) and diabetes mellitus (OR= 9.7 95% CI 17.1– 43.7), the main risk factor for death is the suspension of hemodialysis sessions (OR= 14 95% CI 16.9–68.7). Conclusion: Patients on chronic hemodialysis are at increased risk of SRASCoV-2 infection and mortality from the Covid-19 coronavirus disease. It will be necessary to work to vaccinate these patients as a priority and to maintain the regularity of their weekly sessions by creating an intra-hospital emergency hemodialysis unit.
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