Nephrology and Hypretension

Hemodialysis remains the most widely used means for the treatment of advanced chronic kidney disease. Technological advancement, accessibility and quality of care have led to improve the survival of chronic hemodialysis patients. Maintaining a functional vascular access for hemodialysis at the upper limb for an extended period of time continues to present a challenge for caregivers, hence the interest in knowing other choices for Vascular Access (VA), such as those named exotic. VA for hemodialysis at the lower extremity is the most successful choice of exotic VA when there is an exhaustion of VA site at the upper limb. Within the department of vascular surgery in the university hospital center Mohammed VI (Morocco), 2 VA at the lower extremity were created. The first case concerns a 40 years woman who was admitted for an infection of arteriovenous graft. No post-operative complications were reported, the patient is currently being dialysis thanks to the alternative VA without any issues at 4 years of follow up. A second case of VA at the lower extremity was confectioned in a 75 years old woman, with the vascular factors following: Age, obesity, menopause, high blood pressure and ischemic heart disease. The patient presented a lymphorrhea postoperatively, a few weeks after the intervention, the patient died due to a cardio-circulatory arrest on state of shock in per-dialysis. VA at the lower limb is used infrequently, but it has a good patency. However, it requires frequent revisions in order to detect complications to provide durable access for the dialysis lifetime of the patient.