Patency of Autologous and Prosthetic Arteriovenous Fistulas in Elderly Patients

Staramos, Demetrios N.; Lazarides, Miltos K.; Tzilalis, Vasilios D.; Ekonomou, C.S.; Simopoulos, C.; Dayantas, John N.

doi:10.1080/110241500447407

Cited by 50 publications

(45 citation statements)

References 16 publications

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“…1,4,27 Although the presence of a thrill has previously been used as evidence of technical success, clinical criteria are known to predict eventual maturation poorly. 13 In one study, Won and colleagues found that 93% of fistulas which failed to mature to be used for dialysis had a thrill present postoperatively.…”

Section: Discussionmentioning

confidence: 99%

The impact of training on outcomes in primary vascular access surgery

Weale

Barwell²,

Chant³

et al. 2004

Ann R Coll Surg Engl

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Background: There is evidence that the outcome of arteriovenous fistula surgery is dependent on the surgeon performing the operation. Vascular access surgery provides excellent technical training for surgical trainees. The effect of surgical trainees on the outcome of fistulas was evaluated. Methods: The grade of the main operator for all first attempted (primary) upper limb arteriovenous fistulas, between February 1998 and August 2001, was identified. Median follow-up was 18.0 months (IQR, 6.5-30.1 months). Successful use of fistula for dialysis, fistula patency and survival were assessed. Results: 441 primary fistulas were formed in the study period. Median age was 67.5 years (IQR, 54.0-75.2 years). 71% of all fistulas were formed at the wrist. Trainees performed 31.1% of all operations. The two groups (trainees and consultants) were well matched for age, sex, diabetes, and fistula type. Only 70.5% of patients proceeded to long-term haemodialysis. There were no significant differences in the successful use of AVF for dialysis or patency rates between the two groups. One and two year fistula survival in this group was 87.7% and 78.3% for trainees and 80.8% and 71.1% for consultants (P = 0.288 log rank). Conclusions: Surgical trainees can perform primary AVF surgery without significantly reducing fistula outcomes. Vascular access surgery can be utilised as a training operation.

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Section: Discussionmentioning

confidence: 99%

The impact of training on outcomes in primary vascular access surgery

Weale

Barwell²,

Chant³

et al. 2004

Ann R Coll Surg Engl

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“…Other studies [20,21,22] have cast doubt on the value of creating an AV access in the very elderly starting HD, taking into account their short life expectancy. In addition, the probability of creating a successful AV access in elderly patients is lower than in younger patients, owing to the rigidity and frailty of their vascular network [17,18,19]. …”

Section: Discussionmentioning

confidence: 99%

“…The overall survival of elderly patients is considerably lower, and the number of comorbidities is very high compared to their younger counterparts. Furthermore, several studies have shown that the adequate performance and maturation of a patent AVF for HD is more difficult to achieve in elderly patients owing to the limitations and rigidity of their compromised vascular network [17,18,19]. …”

Section: Introductionmentioning

confidence: 99%

Type of Vascular Access and Survival among Very Elderly Hemodialysis Patients

et al. 2013

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The use of central venous catheters (CVC) for hemodialysis (HD) is associated with higher mortality compared to arteriovenous access (AV). However, studies analyzing the influence of the type of vascular access on the survival of very elderly patients (≥75 years) initiating HD are few and involve only a limited number of patients. We studied a cohort of 5,466 incident patients who started HD; of these, 1,841 were aged ≥75. Types of vascular access for HD were classified as either CVC, which included both tunneled and non-tunneled catheters, or AV, which included AV fistula and grafts. The outcome of the study was all-cause mortality during the follow-up period. In the whole cohort, AV use was associated with a survival advantage over CVC use (88 and 63% at 2 and 5 years, respectively, in patients with an AV as compared to 75 and 48% in patients with a CVC) (p < 0.0001). Among patients ≥75, CVC use was associated with a higher number of deaths compared to AV use. Patients ≥75 with an AV showed a greater survival as compared to patients ≥75 with a CVC (80 and 53% at 2 and 5 years, respectively, vs. 68 and 43%; p < 0.0001). Multivariate analysis revealed that CVC use and the presence of arrhythmia were independent risk factors of death in patients ≥75, whereas obesity was associated with greater survival. In conclusion, the type of vascular access has a significant influence on the survival of very elderly patients (≥75) initiating HD. CVC use was associated with poorer survival compared to AV access.

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“…However, controversy arises concerning the possibility of this principle implementation in elderly patients who, in addition, are often diabetic. The view has even been presented that the construction of an autogenous AVF in the elderly is associated with such a high risk of complications and failure that the formation of a prosthetic fi stula in the arm is the preferred option, especially in the context of a limited life expectancy [4][5][6] .…”

Section: Introductionmentioning

confidence: 99%

Outcome of Autogenous Fistula Construction in Hemodialyzed Patients Over 75 Years of Age

et al. 2006

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Background: There are controversies regarding the feasibility of autogenous vascular access creation in elderly hemodialysis (HD) patients. The aim of this retrospective study was to evaluate the results of creating different types of autogenous arteriovenous fistulas (AVFs) in a consecutive series of HD patients over 75 years of age. Methods: The analysis was performed in 131 patients (65 females, 66 males, average age 79.1 ± 3.6 years) in whom the creation of an autogenous AVF was considered within a 6-year period (February 1998 to February 2004). Among them, 26.7%were diabetics, 66.3% had hypertension, 30.7% were smokers, and 35.6% were obese. Patient survival and primary and secondary AVF patency were assessed. Results: The survival rates for patients were 94, 88, 66, and 45% at 6 months and at 1, 3, and 5 years, respectively. Successful autogenous AVF formation was finally achieved in 107 patients (81.6%): in 99 patients in the forearm and in 8in the upper arm. A Kaplan-Meier analysis showed primary AVF patency rates of: 74 ± 4.3% (± SE) at 1 month; 70 ± 4.7% at 6 months; 59 ± 4.9% at 1 year; 59 ± 4.9% at 2 years; 59± 4.9% at 3 years; 59 ± 4.9% at 4 years, and 58 ± 4.9% at 5 years. The secondary patency rates were: 95 ± 2.0; 92 ± 2.2; 84 ± 3.3; 79 ± 4.0; 72 ± 4.3; 71 ± 4.4, and 69 ± 4.5% in the corresponding periods, respectively. All postoperative complications in 10 patients were treated surgically, if applicable, without endovascular techniques. Conclusions: By exploiting all suitable types of autogenous AVF it is possible to establish the best form of vascular access even in the majority of elderly patients.

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Patency of Autologous and Prosthetic Arteriovenous Fistulas in Elderly Patients

Cited by 50 publications

References 16 publications

The impact of training on outcomes in primary vascular access surgery

The impact of training on outcomes in primary vascular access surgery

Type of Vascular Access and Survival among Very Elderly Hemodialysis Patients

Outcome of Autogenous Fistula Construction in Hemodialyzed Patients Over 75 Years of Age

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