Preferred Strategy for Hemodialysis Access Creation in Elderly Patients

Background Adequate functioning vascular access is the key to successful hemodialysis. The use of an autologous arteriovenous fistula (AVF) is advised because of good long-term patency and a low incidence of complications. However, the number of patients with AVFs is declining because of the change...

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Published inEuropean journal of vascular and endovascular surgery Vol. 49; no. 6; pp. 738 - 743
Main Authors Tordoir, J.H.M, Bode, A.S, van Loon, M.M
Format Journal Article
LanguageEnglish
Published England Elsevier B.V 01.06.2015
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Abstract Background Adequate functioning vascular access is the key to successful hemodialysis. The use of an autologous arteriovenous fistula (AVF) is advised because of good long-term patency and a low incidence of complications. However, the number of patients with AVFs is declining because of the change in the demography of the dialysis population, with increasing numbers of very old patients with multiple comorbidities. Methods In this vignette an elderly patient is described with calcified distal arteries and a small cephalic vein who is referred at a late stage for access creation. The results and performance of different types of vascular access (AVF; arteriovenous graft; central vein catheter), in relation to late referral and patient demographics, are described. In addition, patient morbidity and mortality versus the type of access are discussed. Conclusions The patient described in this vignette appears to be unsuitable for the creation of a forearm AVF because of calcified distal arteries and a small cephalic vein. The risk of non-maturing autologous AVFs is high in elderly patients and this observation might justify the use of early stick grafts. High risk patients may benefit from permanent central vein catheters.
AbstractList Adequate functioning vascular access is the key to successful hemodialysis. The use of an autologous arteriovenous fistula (AVF) is advised because of good long-term patency and a low incidence of complications. However, the number of patients with AVFs is declining because of the change in the demography of the dialysis population, with increasing numbers of very old patients with multiple comorbidities. In this vignette an elderly patient is described with calcified distal arteries and a small cephalic vein who is referred at a late stage for access creation. The results and performance of different types of vascular access (AVF; arteriovenous graft; central vein catheter), in relation to late referral and patient demographics, are described. In addition, patient morbidity and mortality versus the type of access are discussed. The patient described in this vignette appears to be unsuitable for the creation of a forearm AVF because of calcified distal arteries and a small cephalic vein. The risk of non-maturing autologous AVFs is high in elderly patients and this observation might justify the use of early stick grafts. High risk patients may benefit from permanent central vein catheters.
Background Adequate functioning vascular access is the key to successful hemodialysis. The use of an autologous arteriovenous fistula (AVF) is advised because of good long-term patency and a low incidence of complications. However, the number of patients with AVFs is declining because of the change in the demography of the dialysis population, with increasing numbers of very old patients with multiple comorbidities. Methods In this vignette an elderly patient is described with calcified distal arteries and a small cephalic vein who is referred at a late stage for access creation. The results and performance of different types of vascular access (AVF; arteriovenous graft; central vein catheter), in relation to late referral and patient demographics, are described. In addition, patient morbidity and mortality versus the type of access are discussed. Conclusions The patient described in this vignette appears to be unsuitable for the creation of a forearm AVF because of calcified distal arteries and a small cephalic vein. The risk of non-maturing autologous AVFs is high in elderly patients and this observation might justify the use of early stick grafts. High risk patients may benefit from permanent central vein catheters.
BACKGROUNDAdequate functioning vascular access is the key to successful hemodialysis. The use of an autologous arteriovenous fistula (AVF) is advised because of good long-term patency and a low incidence of complications. However, the number of patients with AVFs is declining because of the change in the demography of the dialysis population, with increasing numbers of very old patients with multiple comorbidities.METHODSIn this vignette an elderly patient is described with calcified distal arteries and a small cephalic vein who is referred at a late stage for access creation. The results and performance of different types of vascular access (AVF; arteriovenous graft; central vein catheter), in relation to late referral and patient demographics, are described. In addition, patient morbidity and mortality versus the type of access are discussed.CONCLUSIONSThe patient described in this vignette appears to be unsuitable for the creation of a forearm AVF because of calcified distal arteries and a small cephalic vein. The risk of non-maturing autologous AVFs is high in elderly patients and this observation might justify the use of early stick grafts. High risk patients may benefit from permanent central vein catheters.
Author Tordoir, J.H.M
van Loon, M.M
Bode, A.S
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Keywords Central vein catheter
Arteriovenous fistula
Vascular access
Arteriovenous graft
Hemodialysis
Elderly patients
Language English
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Copyright © 2015 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
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Snippet Background Adequate functioning vascular access is the key to successful hemodialysis. The use of an autologous arteriovenous fistula (AVF) is advised because...
Adequate functioning vascular access is the key to successful hemodialysis. The use of an autologous arteriovenous fistula (AVF) is advised because of good...
BACKGROUNDAdequate functioning vascular access is the key to successful hemodialysis. The use of an autologous arteriovenous fistula (AVF) is advised because...
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SubjectTerms Age Factors
Aged
Arteriovenous fistula
Arteriovenous graft
Arteriovenous Shunt, Surgical - adverse effects
Arteriovenous Shunt, Surgical - mortality
Blood Vessel Prosthesis Implantation - adverse effects
Blood Vessel Prosthesis Implantation - mortality
Catheterization, Central Venous - adverse effects
Catheterization, Central Venous - mortality
Central vein catheter
Comorbidity
Elderly patients
Hemodialysis
Humans
Kidney Failure, Chronic - complications
Kidney Failure, Chronic - diagnosis
Kidney Failure, Chronic - mortality
Kidney Failure, Chronic - therapy
Male
Patient Selection
Renal Dialysis - adverse effects
Renal Dialysis - mortality
Risk Assessment
Risk Factors
Surgery
Time Factors
Treatment Outcome
Upper Extremity - blood supply
Vascular access
Vascular Calcification - complications
Vascular Calcification - diagnosis
Title Preferred Strategy for Hemodialysis Access Creation in Elderly Patients
URI https://www.clinicalkey.es/playcontent/1-s2.0-S1078588415000969
https://dx.doi.org/10.1016/j.ejvs.2015.02.006
https://www.ncbi.nlm.nih.gov/pubmed/25888467
https://search.proquest.com/docview/1698388927
Volume 49
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