CLOSING THE GAP WITHOUT CROSSING BORDERS : A LOCAL SURGICAL MISSION MODEL TO OVERCOME GEOGRAPHIC AND FINANCIAL BARRIERS TO FUNCTIONAL VASCULAR ACCESS IN RURAL CAMEROON

In resource-limited settings, the absence of vascular access surgeons poses a major barrier to sustaible renal replacement therapy. Ngaoundere a referal regional city in northern cameroon face this challenge : despite serving over 200 chronic hemodialysis patients since February 2023, the city has no resident vascular surgeon. As a result, nearly all patients initiate treatment via temporary central venous catheters, a practice linked to elevated risks of bloodstream infection, thrombosis, poor quality of life and mortality. While some patients with sufficient financial means undertake long journeys often exceeding 1,000 km to  the capital city of Yaoundé for arteriovenous fistula (AVF) creation, the vast majority remain confined to catheter-dependent dialysis, facing avoidable complications and psychosocial distress. To break this cycle, we designed and implemented a locally adapted “Vascular Access Surgical Mission” model, strategically timed around World Kidney Day events. This initiative brought visiting vascular surgeons to Ngaoundéré to perform ultrasound-guided AVF creation on-site, aiming to transition patients from temporary to permanent, functional vascular access.

Between February 2023 and August 2025, we identified 35 adult patients (40 ± 12 years) who had been on dialysis exclusively via temporary central venous catheters for 1 to 8 months. All were economically disadvantaged, with less than $50 USD per month. Hypertension was the leading cause of end-stage renal disease (ESRD) in 68% (n=24). Preoperative vascular mapping was performed using point-of-care Doppler ultrasound to assess vessel suitability. Under sterile conditions, visiting vascular surgeons created radiocephalic or brachiocephalic AVFs. Postoperatively, patients were monitored clinically and by Doppler ultrasound at 1 day, 1 week , 1 month, and 3 months. Primary outcomes included AVF maturation rate, early failure (<24h), need for revision, and functional patency at 3 months. Secondary outcomes included catheter-related complications and patient-reported satisfaction.

Of the 35 patients operated, 34 successfully underwent AVF creation (97.1%). One patient was deemed unsuitable intraoperatively due to severe arterial calcification and remained on catheter. Among the 34, one AVF failed within 24 hours (2.9%), two required early surgical revision (5.9%) due to stenosis, and one patient died before 3-month follow-up (2.9%) from unrelated sepsis. At 3 months, 29 of the remaining 32 patients (90.6%) had functional, mature AVFs with adequate flow (>500 mL/min) and no significant stenosis. Two patients developed minor complications: one superficial infection managed conservatively, and one mild steal syndrome resolved spontaneously. Catheter use dropped from 100% pre-intervention to 12.5% (4/32) at 3 months among surviving patients. Patient satisfaction was high, with 92% reporting improved comfort and reduced anxiety about infection risk. Notably, all procedures were performed without general anesthesia using local infiltration only reflecting adaptation to local constraints.

In the absence of permanent vascular surgical capacity, short-term, mission-based interventions can be a viable solution to improve vascular access equity in low-resource regions. Our model timed around global awareness days, leveraging mobile expertise and point-of-care imaging demonstrates that even modest infrastructure can yield high-quality outcomes when combined with strategic planning and community engagement. With a 90.6% functional patency rate at 3 months and minimal complications, this initiative not only improves clinical outcomes but also restores dignity to patients previously confined to temporary catheter dependence. We propose this as a replicable framework for other underserved areas across Sub-Saharan Africa and beyond.