PMID- 21129897
OWN - NLM
STAT- MEDLINE
DCOM- 20110408
LR  - 20121003
IS  - 1097-6809 (Electronic)
IS  - 0741-5214 (Linking)
VI  - 53
IP  - 3
DP  - 2011 Mar
TI  - Creating functional autogenous vascular access in older patients.
PG  - 713-9; discussion 719
LID - 10.1016/j.jvs.2010.09.057 [doi]
AB  - OBJECTIVE: Arteriovenous fistulas (AVFs) are the preferred choice for 
      hemodialysis vascular access (AV access); however, there is debate over the 
      utility of AVFs in older patients, particularly concerning access maturation and 
      functionality. We reviewed our AV access experience in patients >/=65 years of age. 
      METHODS: We analyzed consecutive AV access patients >/=65 years old with access 
      operations between March 2003 and December 2009. All patients had ultrasound 
      vessel mapping. In addition to overall outcomes review, the data for patients >/=65 
      years old were stratified into three 10-year increments by age for further 
      analysis. We compared functional patency data for our older patients with those 
      of our non-elderly patients aged 21 to 64 years treated during the same time 
      period. RESULTS: Four hundred sixty-one consecutive AV access patients new to our 
      practice were included in this study. Ages were 65 to 94 years (mean, 73 years). 
      Two hundred thirty-six (51.2%) were female, 276 (59.9%) patients were diabetic, 
      and 103 (22.3%) were obese. One hundred seven (23.2%) patients had previous 
      access operations. Radiocephalic AVFs were constructed in 29 (6.3%) patients, 99 
      (21.5%) patients had brachial artery inflow AVFs, 330 (71.6%) had proximal radial 
      artery AVFs, and three were based on the femoral artery. Transposition AVFs were 
      used in 124 (26.9%) patients. No grafts were used for AV access in any patient 
      during the study period. Time to AVF use was 0.5 to 6 months (mean, 1.5 months). 
      Primary, primary assisted, and cumulative patency for patients aged 65 to 94 
      years were 59.9%, 93.7%, and 96.9% at 12 months and 45.3%, 90.1%, and 94.6% at 24 
      months, respectively. Follow-up was 1.5 to 77 months (mean, 17.0 months). 
      Subgroup age stratification (65-74 [n = 268], 75-84 [n = 167], 85-94 [n = 26] 
      years) found no statistical difference in functional access outcomes. Primary, 
      primary assisted, and cumulative patency rates were not statistically different 
      in the elderly and non-elderly populations (P = .29, .27, and .37, respectively). 
      One hundred fifty-six patients died during the study period, 1.3 to 61 months 
      (mean, 20 months) after access creation. No deaths were related to access 
      operations. CONCLUSIONS: AVFs are feasible and offer functional and timely AV 
      access in older patients. There was no difference in functional access outcomes 
      for older patients with subgroup age stratification. AVF patency rates were not 
      statistically different in the elderly and non-elderly populations. Cumulative 
      AVF patency for patients >/=65 years of age was 96.9% at 12 months and 94.6% at 24 
      months.
CI  - Copyright (c) 2011 Society for Vascular Surgery. Published by Mosby, Inc. All 
      rights reserved.
FAU - Jennings, William C
AU  - Jennings WC
AD  - Department of Surgery, University of Oklahoma School of Community Medicine, 
      Tulsa, Okla 74135-2512, USA. williamjennings@ouhsc.edu
FAU - Landis, Lesley
AU  - Landis L
FAU - Taubman, Kevin E
AU  - Taubman KE
FAU - Parker, Donald E
AU  - Parker DE
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20101203
PL  - United States
TA  - J Vasc Surg
JT  - Journal of vascular surgery
JID - 8407742
SB  - IM
CIN - J Vasc Surg. 2011 Aug;54(2):597; author reply 597-8. PMID: 21819932
MH  - Adult
MH  - Age Factors
MH  - Aged
MH  - Aged, 80 and over
MH  - *Arteriovenous Shunt, Surgical/adverse effects
MH  - Female
MH  - Graft Occlusion, Vascular/etiology
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Male
MH  - Middle Aged
MH  - Oklahoma
MH  - Proportional Hazards Models
MH  - *Renal Dialysis
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
MH  - Vascular Patency
MH  - Young Adult
EDAT- 2010/12/07 06:00
MHDA- 2011/04/09 06:00
CRDT- 2010/12/07 06:00
PHST- 2010/06/19 00:00 [received]
PHST- 2010/09/17 00:00 [revised]
PHST- 2010/09/17 00:00 [accepted]
PHST- 2010/12/07 06:00 [entrez]
PHST- 2010/12/07 06:00 [pubmed]
PHST- 2011/04/09 06:00 [medline]
AID - S0741-5214(10)02311-6 [pii]
AID - 10.1016/j.jvs.2010.09.057 [doi]
PST - ppublish
SO  - J Vasc Surg. 2011 Mar;53(3):713-9; discussion 719. doi: 
      10.1016/j.jvs.2010.09.057. Epub 2010 Dec 3.