Stretching the boundaries: suitability of an arteriovenous fistula in elderly patients on hemodialysis—a northern India experience

Purpose Considering various factors, such as multiple co-morbidities, unsuitable vessels for access creation, non-maturation, vascular calcifications, the outcome of arteriovenous fistula (AVF) in the elderly population, may not be similar to the younger people. Our study aims to analyze the outcome...

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Bibliographic Details
Published in:International urology and nephrology 2022-03, Vol.54 (3), p.671-678
Main Authors: meena, Priti, bhargava, Vinant, Sehrawat, Sumit, Rana, Devinder Singh, Bhalla, Anil Kumar, Gupta, Ashwani, Malik, Manish, Gupta, Anurag, Tiwari, Vaibhav
Format: Article
Language:English
Subjects:
Aged
Arteriovenous Shunt, Surgical
Female
Fistula
Fistulae
Hemodialysis
Humans
India
Male
Medicine
Medicine & Public Health
Nephrology
Nephrology - Original Paper
Older people
Prospective Studies
Renal Dialysis
Thrombosis
Transposition
Treatment Outcome
Urology
Venous access
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Summary:Purpose Considering various factors, such as multiple co-morbidities, unsuitable vessels for access creation, non-maturation, vascular calcifications, the outcome of arteriovenous fistula (AVF) in the elderly population, may not be similar to the younger people. Our study aims to analyze the outcomes of AVF in elderly patients (> 65 year). Methods It was a prospective observational study. Patients of more than 65 years of age in whom AVF was created from January 2012 to December 2015 were included in the study. These patients were followed up for 4 years. The primary endpoint of our study was to assess primary and secondary patency rates. Results A total of 450 AVFs were included in the study. The mean age was 68.5 years. The most common site of AVF was radiocephalic (RCAVF) in 70% ( n  = 315), brachiocephalic (BCAVF) in 24% ( n  = 108) and basilic vein transposition (BVT) in 6% ( n  = 27). At 48 months, the primary patency rate of RCAVF, BCAVF, and BVT was 55%, 61.6%, and 60.4%, respectively. The commonest cause of access failure was thrombosis followed by non-maturation. Conclusion AVF remains the preferred vascular access for hemodialysis even in the elderly population. Failure to mature and thrombosis continue to be a concern with AVF. Location of the AV access does not seem to impact the long-term patency.
ISSN:0301-1623
1573-2584
DOI:10.1007/s11255-021-02941-4