[Vascular access in elderly: AVF versus CVC]

The characteristics of patients on dialysis have changed significantly in the last years. Aging and comorbidity are the most important aspects of this change. Vascular access problems are frequent in elderly people and contribute to the increased morbidity and mortality. Arteriovenous fistula (AVF) remains the preferred method but may be difficult or unadvisable in older patients because of a short life expectancy, poor vasculature or poor cardiac function. In fact, increasing use of CVC has been reported in recent studies. Psychological and quality of life-related aspects should also be taken into account when scheduling vascular access in older patients: from this point of view CVC may be a good alternative to an aggressive surgical policy. Decreasing CVC-related complications is feasible through the consistent application of basic rules; the center effect may be relevant in this context. However, the use of CVC remains a kind of double-edged sword: even in older people preferring it over AVF is justified only if good results can be guaranteed. The final choice will have to be based on a multidisciplinary approach and careful assessment of resources.