Outcomes of primary arteriovenous fistulas in patients aged over 70

Background The population of elderly hemodialysis patients is increasing, yet the most suitable approach for providing permanent hemodialysis access remains unclear. Here we report outcomes using an approach aimed predominantly at creating radiocephalic fistulas. Methods A single center retrospective cohort study was performed in which access outcomes for primary arteriovenous fistulas created between 1st January 2005 and 31st Dec 2012 in patients aged 70 or over were compared. Results During the study period, 204 radiocephalic, 1 brachiobasilic and 9 brachiocephalic primary fistulas were created initially for patients requiring dialysis. Immediate failure rates for radiocephalic fistulas were lower than brachiocephalic fistulas but not significantly so (12% vs 22%; P=.319, Fisher’s exact test). One-year primary and secondary patency for radiocephalic fistulas was 54% and 66%, respectively, and similar for those created in patients between 70 and 80 years old and in those over 80. Secondary patency rates at one year for radiocephalic fistulas utilizing cephalic vein of diameter less than 2.5mm was lower than for fistulas created with cephalic vein greater than 2.5mm (49% vs 72%, P=.005, Log-rank test). Creation of a brachiocephalic fistula was associated with a significantly higher incidence of steal syndrome than with a radiocephalic fistula (10% vs 2%, P=.009, Fisher’s exact test). Conclusion Radiocephalic fistulas formed in the elderly carry a lower risk of steal syndrome than brachiocephalic fistulas, and offer the potential for further revision surgery, such that acceptable secondary patency is achieved for radiocephalic fistulas formed utilizing even small (