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Published on: April 1, 2022
Outcomes of radiocephalic arteriovenous fistula in octogenarians
Raffaella Mauro1, Alessia Pini1, Rodolfo Pini1
1Vascular Surgery Unit, IRCCS University Hospital, Policlinico S. Orsola-Malpighi, Bologna, Italy.
Insights
Radiocephalic arteriovenous fistula (RCAVF) is a recommended hemodialysis access. In octogenarians, RCAVF efficacy is comparable to younger patients when central venous catheter use is avoided, demonstrating good outcomes.
Area of Science:
- Vascular Surgery
- Nephrology
- Geriatric Medicine
Background:
- Radiocephalic arteriovenous fistula (RCAVF) is the recommended first-choice vascular access for hemodialysis.
- Current guidelines lack specific indications for RCAVF use in octogenarian patients.
- This study evaluates the efficacy of RCAVF in octogenarians compared to younger individuals.
Purpose of the Study:
- To assess the efficacy and outcomes of radiocephalic arteriovenous fistula (RCAVF) in octogenarian patients.
- To compare the primary patency (PP) and assisted patency (AP) rates of RCAVF in patients aged 80 years and older versus younger patients.
- To identify risk factors associated with reduced RCAVF patency in octogenarians.
Main Methods:
- A retrospective analysis of a prospective database of patients who underwent RCAVF from January 2013 to December 2017.
- Patients were divided into two groups: <80 years old and ⩾80 years old.
- Data collected included demographics, comorbidities, and dialytic treatment. Primary (PP) and assisted patency (AP) were the main endpoints.
Main Results:
- A total of 294 RCAVFs were analyzed; 49 were in patients ⩾80 years old.
- Two-year PP and AP for the overall cohort were 69% ± 2% and 73% ± 3%, respectively.
- Octogenarians (⩾80 years) showed significantly lower 2-year PP (50% ± 8%) and AP (62% ± 7%) compared to younger patients (73% ± 3% and 75% ± 3%, p<0.05).
- Previous central venous catheter (CVC) use was identified as a significant predictor of earlier RCAVF failure in octogenarians (HR 3.03, p=0.01).
- In the absence of prior CVC use, octogenarians had similar 2-year PP (59% ± 10%) compared to younger patients (72% ± 4%, p=0.46).
Conclusions:
- Radiocephalic arteriovenous fistula (RCAVF) demonstrates satisfactory results in octogenarians, even with lower overall patency rates.
- Avoiding central venous catheter (CVC) use is crucial for successful RCAVF outcomes in elderly patients.
- When performed without a history of CVC, RCAVF can be considered a first-choice vascular access for octogenarians.
Background:
Current guidelines recommend radiocephalic arteriovenous fistula (RCAVF) as a first choice access for hemodialysis, without specific indication for octogenarians .This study was undertaken to assess the efficacy of RCAVF in octogenarians compared with younger patients.
Material And Methods:
All patients treated by RCAVF from January 2013 to December 2017 were included in a prospective database for a retrospective analysis. Patient demographics, comorbidities, and dialytic treatment data were collected prospectively and compared in patients <80 year-old and ⩾80 years-old. Clinical surveillance was performed during each dialysis session. The main endpoints were primary (PP) and assisted patency (AP).
Results:
Within the study period, a total of 294 RCAVF were analyzed: 245 (83.3%) RCAVF were performed in <80 year-old and 49 (16.7%) ⩾80 years old. The overall PP and AP at 2-year was 69% ± 2% and 73% ± 3%, respectively. Patients ⩾ 80 years-old had a significantly reduced 2-year PP, AP of RCAVF compared with the younger patients: 50% ± 8% and 62% ± 7% versus 73% ± 3% and 75% ± 3%, p = 0.01 and p = 0.03, respectively.The analysis for possible risk factors for reduction of PP in patients ⩾80 years identified in the central venous catheter(CVC) a predictor of earlier RCAVF failure: HR 3.03(95% CI 1.29-7.13), p = 0.01.Kaplan-Meier curve confirms the reduction of PP in ⩾80 years old patients at 2-year follow-up with previous CVC compared patients without history of CVC: 59% ± 10% versus 24% ± 11%, p = 0.01. A comparison between the two groups was made in order to evaluate the impact of previous history of CVC .In absence of a history of CVC use older patients had a similar 2-year PP compared with younger patients: 59% ± 10% versus 72% ± 4%, p = 0.46. Otherwise, the history of a previous CVC reduced significantly the 2-year PP in ⩾80 years old patients compared the younger: 24% ± 12% versus 75% ± 5%, p = 0.0001.
Conclusions:
Despite lower overall primary and primary assisted patency, RCAVF are associated with satisfactory results also in octogenarians if performed in absence of history of CVC. Under these circumstances RCAVF can be considered a first choice treatment.
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