[Distal vascular access for chronic hemodialysis in patients over 65 years of age. Surgical results].
OBJECTIVE
To evaluate the results of vascular accesses for chronic haemodialysis in elderly patients.


METHODS
56 consecutive vascular accesses for haemodialysis were performed from November 1993 to December 1995 in patients over the age of 65 years. The policy adopted was to prefer distal accesses: only forearm accesses, primary arteriovenous fistula (AVF) or radio-M venous bioprosthesis shunt (AVS) were performed. Surgical or interventional radiological reoperation rates and abandonment rates were evaluated.


RESULTS
13 AVF (mean age: 74.5 years) and 43 AVS (mean age: 73.8 years) were analysed. The mean number of reoperations was significantly higher in the shunt group. 1 out of 13 AVF was abandoned versus 9 out of 43 AVS (no significant difference).


CONCLUSIONS
AVS gave poor results in terms of reoperation rate, inducing a high cost and impairment of the quality of life of these patients. Their survival in this population was comparable to that of AVF. Several teams prefer to perform first-line humero-cephalic or humero-basilic arteriovenous fistulas whenever a simple fistula in the forearm cannot be performed. They appear to give better results, but their use in the elderly is poorly evaluated. Peritoneal dialysis may be preferable to haemodialysis in the elderly. As vascular accesses are increasingly performed in elderly subjects with a reduced life expectancy, protection of the proximal venous capital does not appear to be a sufficient argument to justify the use of AVS in this population.


CONCLUSIONS
This study encouraged us to abandon the use of prostheses in the forearm in favour of direct accesses in the arms.
Cante
P
P
Service d'Urologie, CHU de Caen, France.
Bottet
P
P
Ryckelynck
J P
JP
Le Roch
B
B
Levaltier
B
B
Lobbedez
T
T
Bensadoun
H
H
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000191:economics; D001705:Bioprosthesis; D001807:Blood Vessel Prosthesis / Q000009:adverse effects / Q000191:economics; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000191:economics; D003251:Constriction, Pathologic / Q000209:etiology; D004868:Equipment Failure; D005069:Evaluation Studies as Topic; D005542:Forearm / Q000098:blood supply; D017048:Health Care Costs; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008017:Life Expectancy; D010530:Peritoneal Dialysis; D011788:Quality of Life; D015642:Radiology, Interventional; D006435:Renal Dialysis / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D012086:Reoperation; D013927:Thrombosis / Q000209:etiology
Abords vascularies distaux pour hémodialyse chronique après 65 ans. Résultats chirurgicaux.