Creation of autogenous radial cephalic direct wrist access for hemodialysis in the elderly using microsurgery.
OBJECTIVE
Guidelines recommend autogenous radial-cephalic AV fistula (RCAVF) as the first choice for hemodialysis. Concern has been raised that this is not suitable in the elderly. We assessed the results of microsurgery for RCAVF creation comparatively in patients older and younger than 70 years.


METHODS
We prospectively followed 126 patients for three years. After systematic clinical and ultrasound assessment, a RCAVF was created using a surgical microscope. Patency was assessed immediately, at one week, one month and one year. Outcomes were recorded and stratified into two groups: <70y and >70y.


RESULTS
RCAVF was created in 75.4% and 70.8% of the <70y and >70y groups, respectively. Incidence of early failure was 11% (<70y) and 13% (>70y). Primary and secondary patency at one year was 67% and 84% (<70y) versus 63% and 80% (>70y).


CONCLUSIONS
Microsurgery enabled the creation of RCAVF in >70y with acceptable risk of failure and slight differences by comparison with <70y. Older age should not preclude RCAVF creation.
Department of Clinical and Molecular Medicine, Sapienza University, Division of Nephrology, Sant'Andrea Hospital, Rome - Italy.
Nicola
N
Pirozzi
Anna
A
Giuliani
Tommaso
T
Grandi
Daniela
D
Coclite
Remo
R
Luciani
Giorgio
G
Punzo
Paolo
P
Menè
D000367:Age Factors; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008866:Microsurgery / Q000009:adverse effects; D018579:Patient Selection; D011183:Postoperative Complications / Q000503:physiopathology / Q000628:therapy; D011446:Prospective Studies; D017534:Radial Artery / Q000503:physiopathology / Q000601:surgery*; D006435:Renal Dialysis; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D014953:Wrist / Q000098:blood supply*