Preferred Strategy for Hemodialysis Access Creation in Elderly Patients

J. H. M. Tordoir*, A. S. Bode, M. M. van Loon

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

23 Citations (Web of Science)

Abstract

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.
Original languageEnglish
Pages (from-to)738-743
JournalEuropean Journal of Vascular and Endovascular Surgery
Volume49
Issue number6
DOIs
Publication statusPublished - Jun 2015

Keywords

  • Vascular access
  • Hemodialysis
  • Elderly patients
  • Central vein catheter
  • Arteriovenous fistula
  • Arteriovenous graft

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