title: [Exhaustion of vascular capital in patients on hemodialysis: what will be the outcome?]
abstract: Despite advances in the treatment of chronic renal failure, vascular access remains the weakest link in renal replacement therapy (RRT) and the leading cause of morbidity in patients on hemodialysis We report the case of a young female patient with chronic renal insufficiency secondary to vascular nephropathy on periodic hemodialysis and whose vascular capital was early exhausted due to iterative thromboses in arteriovenous fistulas and failure in peritoneal dialysis. Protein C deficiency was objectified. The patient underwent tunneled hemodialysis catheter insertion at the level of the right atrium via a right anterolateral thoracotomy with cannulation of the inferior vena cava, with poor functional outcome after three months of use. Since then she has been dialyzed using puncture of the external jugular veins.
authors.affiliation: Service de Médecine Interne A, Hôpital Charles Nicolle, Tunis, Tunisie; Laboratoire de Pathologie Rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie.
authors.forename: Meriam
authors.initials: M
authors.lastname: Hajji
authors.affiliation: Service de Médecine Interne A, Hôpital Charles Nicolle, Tunis, Tunisie; Laboratoire de Pathologie Rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie.
authors.forename: Amel
authors.initials: A
authors.lastname: Harzallah
authors.affiliation: Service de Médecine Interne A, Hôpital Charles Nicolle, Tunis, Tunisie; Laboratoire de Pathologie Rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie.
authors.forename: Hayet
authors.initials: H
authors.lastname: Kaaroud
authors.affiliation: Service de Médecine Interne A, Hôpital Charles Nicolle, Tunis, Tunisie; Laboratoire de Pathologie Rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie.
authors.forename: Mona
authors.initials: M
authors.lastname: Jerbi
authors.affiliation: Service de Médecine Interne A, Hôpital Charles Nicolle, Tunis, Tunisie; Laboratoire de Pathologie Rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie.
authors.forename: Soumaya
authors.initials: S
authors.lastname: Chargui
authors.affiliation: Service de Médecine Interne A, Hôpital Charles Nicolle, Tunis, Tunisie; Laboratoire de Pathologie Rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie.
authors.forename: Fethi El
authors.initials: FE
authors.lastname: Younsi
authors.affiliation: Laboratoire de Pathologie Rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie; Faculté de Médecine de Tunis, université Tunis El Manar, Tunis, Tunisie.
authors.forename: Fethi Ben
authors.initials: FB
authors.lastname: Hamida
authors.affiliation: Service de Médecine Interne A, Hôpital Charles Nicolle, Tunis, Tunisie; Laboratoire de Pathologie Rénale LR00SP01, Hôpital Charles Nicolle, Tunis, Tunisie.
authors.forename: Taieb Ben
authors.initials: TB
authors.lastname: Abdallah
mesh_terms: D000293:Adolescent; D001164:Arteriovenous Fistula / Q000473:pathology; D005260:Female; D006801:Humans; D020151:Protein C Deficiency / Q000175:diagnosis; D006435:Renal Dialysis / Q000379:methods*; D051436:Renal Insufficiency, Chronic / Q000209:etiology / Q000628:therapy*; D013927:Thrombosis / Q000473:pathology; D014652:Vascular Diseases / Q000150:complications*; D014682:Vena Cava, Inferior
keywords: Hemodialysis; thrombosis; vascular access