Best Vascular Access in the Elderly: Time for Innovation?

Area of Science:

• Nephrology
• Vascular Surgery
• Geriatric Medicine

Background:

• Optimal dialysis access for the elderly remains debated, with differing views on catheters versus arteriovenous fistulas.
• Arteriovenous fistulas offer superior long-term dialysis access but face high early failure rates in the elderly population.
• Upper arm fistulas demonstrate significantly lower failure rates compared to forearm fistulas in elderly patients.

Purpose of the Study:

• To discuss arteriovenous fistula creation in the elderly.
• To highlight critical factors for successful fistula creation in this demographic.
• To describe two innovative percutaneous techniques for upper arm fistula establishment.

Main Methods:

• Review of existing data on dialysis access in the elderly.
• Description of two novel percutaneous techniques for upper arm arteriovenous fistula creation.
• Emphasis on techniques that avoid surgical manipulation of the juxta-anastomotic region.

Main Results:

• Innovative percutaneous techniques successfully establish upper arm fistulas in the elderly.
• These techniques utilize proximal radial/ulnar artery inflow.
• The described methods bypass open surgical exploration, mitigating risks of juxta-anastomotic stenosis and early fistula failure.

Conclusions:

• Percutaneous upper arm fistula creation presents a viable and successful option for elderly patients requiring dialysis access.
• Innovative techniques offer a robust platform to overcome challenges associated with fistula creation in the elderly.
• Minimizing surgical manipulation through these techniques can lead to improved early fistula patency rates.