title: Survival and complications of arteriovenous fistula dialysis access in an elderly population.
abstract: OBJECTIVE
  In recent years, the number of elderly uremic patients who commence renal replacement therapy has increased. A retrospective review assessed the survival rate and incidence of complications in elderly patients with an arteriovenous fistula (AVF) created between January 2000 and August 2008.
  
  
  METHODS
  A total of 78 patients, 48 men and 30 women aged ≥75 with a mean age of 82.5±7.5, commenced hemodialysis therapy during the period under consideration; 31% were diabetic and all had a LVEF ≥30%. For this group of patients, 90 AVF were created: 41 distal AVF (45%), 32 proximal AVF (35%), 13 midarm AVF (15%), and four AV grafts (5%).
  
  
  RESULTS
  The survival rate of the AVF was 76% at 12 months and 71% at 24 months. A total of 47 patients with functioning AVF (60%) died during the study period. There were 18 cases of thrombosis (20%). No significant local or systemic complications occurred.
  
  
  CONCLUSIONS
  Several aspects should be highlighted: pre-operative color-flow duplex scanning, timing of the creation of the AVF and placement of the AVF as distal as possible.The creation of AVF in elderly patients is a choice supported by the opinion that patients with tunneled central venous catheters have higher mortality rates than those with AVF. In summary, choosing vascular access sites to be created in elderly patients is no different than for younger patients-an AVF remains the gold standard.
authors.affiliation: Struttura Complessa Nefrologia e Dialisi, Verbania - Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Borzumati
authors.forename: Loredana
authors.initials: L
authors.lastname: Funaro
authors.forename: Elvira
authors.initials: E
authors.lastname: Mancini
authors.forename: Valerio
authors.initials: V
authors.lastname: Resentini
authors.forename: Adriana
authors.initials: A
authors.lastname: Baroni
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006083:Graft Occlusion, Vascular / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D006435:Renal Dialysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013927:Thrombosis / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*