Preferred strategy for hemodialysis access creation in elderly patients

Area of Science:

• Nephrology
• Vascular Surgery

Background:

• Vascular access is crucial for hemodialysis success.
• Autologous arteriovenous fistulas (AVFs) offer good patency and low complications.
• Demographic shifts, including an aging dialysis population with comorbidities, are decreasing AVF use.

Purpose of the Study:

• To describe vascular access options for an elderly patient with late referral and comorbidities.
• To compare the performance of AVFs, arteriovenous grafts, and central vein catheters in this demographic.
• To discuss patient morbidity and mortality in relation to access type.

Main Methods:

• Case vignette of an elderly patient with calcified arteries and small cephalic vein.
• Review of AVF, arteriovenous graft, and central vein catheter outcomes.
• Discussion of late referral and patient demographics impact on access selection.

Main Results:

• The described patient was unsuitable for a forearm AVF due to vascular anatomy.
• High risk of non-maturing AVFs in elderly patients with comorbidities.
• Arteriovenous grafts and central vein catheters are viable alternatives.

Conclusions:

• Forearm AVF creation is contraindicated in the presented case.
• Early consideration of arteriovenous grafts may be warranted for high-risk elderly patients.
• Permanent central vein catheters can be beneficial for high-risk hemodialysis patients.