[Vascular access for dialysis in elderly: AVF versus permanent CVC]

Area of Science:

• Nephrology
• Vascular Surgery
• Medical Devices

Background:

• Vascular access type significantly impacts hemodialysis outcomes and patient morbidity/mortality.
• Complications associated with vascular access can negatively affect patient health.
• The Cimino Brescia fistula is the preferred vascular access, followed by grafts, while tunneled central venous catheters are a 'second choice' due to higher complication rates.

Purpose of the Study:

• To evaluate the effectiveness of different hemodialysis vascular access types.
• To assess the suitability of arteriovenous fistulas (AVFs) in elderly patients.
• To guide the selection of optimal vascular access to reduce complications.

Main Methods:

• Review of existing literature on hemodialysis vascular access.
• Analysis of complication rates associated with fistulas, grafts, and catheters.
• Consideration of instrumental tests like echo-color Doppler and angiography for vascular bed assessment in elderly patients.

Main Results:

• Native fistulas are ideal, followed by grafts; catheters present higher risks of thrombosis and infection.
• Elderly patients' vascular beds may be compromised, but AVFs can often still be created successfully.
• Age alone should not preclude AVF creation in suitable elderly patients.

Conclusions:

• Optimal patient and site selection by nephrologists and vascular surgeons is key to successful vascular access.
• Limiting the use of 'second choice' accesses like central catheters can improve patient outcomes.
• Elderly patients can benefit from AVFs, challenging the notion that age limits access options.