title: Fistulas in octogenarians: are they beneficial?
abstract: BACKGROUND
  The incidence of end-stage renal disease is increasing most rapidly in patients aged older than 75 years. Meanwhile, their 5-year survival rate remains the lowest of any dialysis cohort. The purpose of this study was to evaluate the benefit of arteriovenous fistula (AVF) construction in octogenarians, as the data regarding the effects of age on fistula success are conflicting.
  
  
  METHODS
  Using our hemodialysis database, we performed a retrospective review of all AVFs placed between 1 November, 2007, and 17 July, 2013, in patients aged 80 years or older. Patient demographics, presence of catheters, time to first fistula use, fistula interventions, fistula patency, and time to patient death were all evaluated.
  
  
  RESULTS
  We placed 32 fistulas in 31 patients. Our average patient was 82-year-old, men (75%) and Caucasian (71%). Three patients were excluded, as they never required dialysis. One patient required 2 fistulas; the second fistula was excluded from analysis. Of the remaining 28 patients, 22 (78%) were used for hemodialysis and 19 (68%) required catheter-based dialysis before fistula use. The mean length of catheter use was 166 days, and the median time to first fistula use was 109 days. Primary functional patency was 51% at year 1 and 38% at year 2, respectively. Secondary patency was 75% at year 1 and year 2. Of the 22 patients, 17 (77%) required intervention to achieve or maintain patency. The median time to death was 26 months.
  
  
  CONCLUSIONS
  With substantial effort, successful fistula utilization can be achieved in an extremely elderly patient population. Our patients experienced significant catheter utilization and over 3 quarters required secondary interventions to achieve or maintain fistula utilization. Given this group's limited survival and the fact that 21% of their survival time was spent dialyzing with a catheter, the benefit of a functioning fistula to a patient older than 80 years can be questioned.
authors.affiliation: Department of Surgery, Greenville Health System, Greenville, SC.
authors.forename: Kevin T
authors.initials: KT
authors.lastname: Claudeanos
authors.affiliation: Department of Surgery, Greenville Health System, Greenville, SC.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Hudgins
authors.affiliation: Department of Surgery, Greenville Health System, Greenville, SC.
authors.forename: Gail
authors.initials: G
authors.lastname: Keahey
authors.affiliation: Department of Surgery, Greenville Health System, Greenville, SC.
authors.forename: David L
authors.initials: DL
authors.lastname: Cull
authors.affiliation: Department of Surgery, Greenville Health System, Greenville, SC. Electronic address: ccarsten@ghs.org.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Carsten
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D016208:Databases, Factual; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008297:Male; D009657:North Carolina / Q000453:epidemiology; D018579:Patient Selection; D006435:Renal Dialysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency