Abstract: FR-PO771
Age Is Not Everything – Vascular Access for Hemodialysis in the Elderly
Session Information
- Hemodialysis: Vascular Access - II
November 03, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Dialysis
- 603 Hemodialysis: Vascular Access
Authors
- Mannheim, Dallit, Carmel Medical Center, Haifa, Israel
- Tanasiychuk, Tatiana, Carmel Medical Center, Haifa, Israel
- Frajewicki, Victor, Carmel Medical Center, Haifa, Israel
Background
Old patients are the fastest growing incidence dialysis age-group, having increased by 57% over the last decade. Indeed, people aged more than 75 are now over 1/5 of dialysis patients. Even though arteriovenous fistulas (AVF) are the preferred vascular access for hemodialysis, with the lowest rate of morbidity and mortality, the best vascular access in the elderly is still unclear. This controversy is further accentuated by a longer maturation time of AVF and shorter life expectancy. To promote a better planning and follow-up of patients undergoing operations for vascular access at our center we initiated a multi-disciplinary clinic: every single patient is routinely evaluated before and after the operation at least by a vascular surgeon and a nephrologist.
Methods
The goal of this study was to retrospectively evaluate the outcome in patients assessed by a multi-disciplinary clinic which have undergone operations for the creation of a vascular access during 2015-2016. Primary endpoint was the rate of a functioning mature vascular access, either a fistula or a graft.
Results
During the period 291 operations for vascular access were done. All patients were evaluated by a vascular surgeon and nephrologist before the operation. Patients without clinical obvious arm or forearm cephalic veins were further evaluated by venous mapping. Male:female ratio was 3:1, Diabetes was present in 58%. 119 patients (41%) were evaluated before onset of dialysis. A primary fistula was created in 92% of cases; radio- cephalic 39%, brachio- cephalic 43%, brachio- basillar in 11%. In 17 (6%), grafts were inserted. Five patients experienced post-operative complications (including 4 cases of steal syndrome and 1 of venous hypertension). Of these, only 1 was an elder patient. Maturity was achieved in 202 accesses (73%). In 2 cases an angioplasty was needed to assist maturation. Age did not correlate with maturation as both a categorical as well as a continuous parameter for all age groups (including over 75, 80 or 85)
Conclusion
Implementation of a multi-disciplinary trained team to take care of the growing elderly population requiring dialysis is highly advised. This kind of program not only leads to a higher rate of successful vascular access but also avoids unnecessary surgical interventions and complications in patients that will not enjoy from such procedures.