title: Vascular access thrombosis in France: incidence and treatment patterns.
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.
authors.affiliation: Department of Vascular Surgery, University Hospital of Nice, Nice, France; University of Nice-Sophia Antipolis, Nice, France.
authors.forename: Nirvana
authors.initials: N
authors.lastname: Sadaghianloo
authors.affiliation: Department of Vascular Surgery, University Hospital of Nice, Nice, France; University of Nice-Sophia Antipolis, Nice, France.
authors.forename: Elixène
authors.initials: E
authors.lastname: Jean-Baptiste
authors.affiliation: University of Nice-Sophia Antipolis, Nice, France; Department of Nephrology and Dialysis, University Hospital of Nice, Nice, France.
authors.forename: Mohammed S
authors.initials: MS
authors.lastname: Islam
authors.affiliation: Department of Surgery, Yale University Medical School, New Haven, CT.
authors.forename: Alan
authors.initials: A
authors.lastname: Dardik
authors.affiliation: Department of Vascular Surgery, University Hospital of Nice, Nice, France; University of Nice-Sophia Antipolis, Nice, France.
authors.forename: Serge
authors.initials: S
authors.lastname: Declemy
authors.affiliation: Department of Vascular Surgery, University Hospital of Nice, Nice, France; University of Nice-Sophia Antipolis, Nice, France. Electronic address: hassen-khodja@chu-nice.fr.
authors.forename: Réda
authors.initials: R
authors.lastname: Hassen-Khodja
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001291:Attitude of Health Personnel; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D005602:France / Q000453:epidemiology; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation; D006435:Renal Dialysis; D011795:Surveys and Questionnaires; D013927:Thrombosis / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler