title: Vascular access for hemodialysis in the elderly.
abstract: OBJECTIVE
  The number of elderly patients needing hemodialysis is constantly increasing year by year. Elderly patients with end-stage renal failure represent a challenge for the surgeons who create vascular accesses. The aim of this study was to analyze the outcome of conduit creation in the elderly in our institution and to compare it with the outcome of a cohort of patients aged <65 years.
  
  
  METHODS
  The study was performed retrospectively on prospectively collected data. The study period was between January 1, 2000, and December 31, 2006. We identified first attempts at conduit creations, including arteriovenous fistulas (AVFs) and grafts, in elderly patients (aged ≥65 years) who were allocated to group A, and in nonelderly patients (<65 years) who were allocated to group B. Subsequent attempts at conduit creations in the same patient were omitted from the data set.
  
  
  RESULTS
  There were 246 first AVFs in group A and 89 in group B. At a mean follow-up of 25.46 months (SD, 18.93 months), the primary patency (PP) rate of all AVFs was 70% in group A and 68% in group B (P = .75). The assisted PP rate was 73% in group A and 77% in group B (P = .4). The secondary patency (SP) rate was 73% in group A and 79% in group B (P = .9). Also, the differences in the 12-month cumulative patency rates (including PP, assisted PP, and SP) in the two groups (65% vs 60%) were not significant. At a mean follow-up of 25 months, death with a functioning conduit occurred at the same rate in both groups (56% and 54%), and mean conduit survival did not differ according to age (516 and 511 days). The incidence of failure to mature was higher in group A (6.1% vs 1.1%, P = .03). Patency rates for different types of conduits were similar between the two groups, although polytetrafluoroethylene grafts had a higher cumulative patency in group A (94% vs 69%; P = .05). The rate of procedures to salvage conduits was 2.5% in group A vs 10.1% in group B. Mean hospital stay for group A and group B was 3.2 days.
  
  
  CONCLUSIONS
  In our experience, the creation of permanent hemodialysis access in the elderly with AVF is not only possible but also proved to have a short hospital stay, high patency rates, and an acceptable rate of further intervention.
authors.affiliation: Department of Transplant Surgery, Guy’s and St Thomas’ NHS Foundation Trust, United Kingdom. nicola.swindlehurst@doctors.org.uk
authors.forename: Nicola
authors.initials: N
authors.lastname: Swindlehurst
authors.forename: Andrew
authors.initials: A
authors.lastname: Swindlehurst
authors.forename: Heather
authors.initials: H
authors.lastname: Lumgair
authors.forename: Irene
authors.initials: I
authors.lastname: Rebollo Mesa
authors.forename: Nizam
authors.initials: N
authors.lastname: Mamode
authors.forename: Roberto
authors.initials: R
authors.lastname: Cacciola
authors.forename: Iain
authors.initials: I
authors.lastname: Macdougall
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D016009:Chi-Square Distribution; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008131:London; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D006435:Renal Dialysis; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*; D014654:Vascular Patency; D055815:Young Adult