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Creating functional autogenous vascular access in older patients.

William C Jennings1, Lesley Landis, Kevin E Taubman

  • 1Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, Okla 74135-2512, USA. williamjennings@ouhsc.edu

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|December 7, 2010
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Arteriovenous fistulas (AVFs) provide effective hemodialysis access in patients aged 65 and older, showing comparable outcomes to younger individuals. These fistulas offer functional and timely vascular access with high patency rates in the elderly population.

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Area of Science:

  • Vascular Surgery
  • Nephrology
  • Geriatric Medicine

Background:

  • Arteriovenous fistulas (AVFs) are the preferred vascular access for hemodialysis.
  • Concerns exist regarding AVF utility, maturation, and functionality in elderly patients (≥65 years).

Purpose of the Study:

  • To evaluate the feasibility, functionality, and outcomes of AVFs in patients aged 65 years and older.
  • To compare AVF outcomes in elderly patients with those in a non-elderly population.

Main Methods:

  • Retrospective analysis of 461 consecutive AV access patients ≥65 years old (March 2003-December 2009).
  • All patients underwent ultrasound vessel mapping; data stratified by age (10-year increments).
  • Comparison of functional patency data with non-elderly patients (21-64 years).

Main Results:

  • Elderly cohort (65-94 years): 12-month primary, assisted primary, and cumulative patency were 59.9%, 93.7%, and 96.9%.
  • No statistical difference in functional access outcomes between elderly subgroups or compared to non-elderly patients.
  • Cumulative AVF patency in patients ≥65 years was 96.9% at 12 months and 94.6% at 24 months.

Conclusions:

  • Arteriovenous fistulas are feasible and provide functional, timely vascular access for older patients.
  • No significant differences in functional access outcomes were observed across elderly age strata.
  • AVF patency rates in elderly patients are comparable to those in younger populations.