Joseph Faraj1, Ali Daneshmand1, Monique Sandford1,3, Jackie Wong1,4, Benjamin Dak Keung Leong5, Vikram Vijayan Sannasi1 and Bibombe Patrice Mwipatayi1,2,3,4*
1Department of Vascular Surgery, Royal Perth Hospital, Australia
2Department of Surgery, University of Western Australia, Australia
3Renal access unit, Royal Perth Hospital, Australia
4Department of Medical Research, Royal Perth Hospital, Australia
5Unit of Vascular Surgery, Queen Elizabeth Hospital 2, Malaysia
Background: A significant number of elderly patients ( ≥ 80 years) with end-stage renal disease require haemodialysis. We hypothesized that octogenarians would have poorer outcomes given the higher prevalence of comorbidities. The aim of our study was to analyze the outcome of Arteriovenous Fistula (AVF) creation in this group of patients. Methods: A retrospective analysis of a prospectively collected renal access database between 2011 and 2014 was performed. Outcome measures included AVF usage, patency rates, re-intervention, and factors associated with failure to use the AVF. Cox regression survival analysis was used to compare patency rates. Results: A total of 530 AVFs were created within the study period, of which 31 (5.8%) were created in octogenarians. From this population, 23 patients did not use their fistula within the follow-up period (AVF-not used group), with only 8 undergoing haemodialysis through their fistula (AVFused group). Primary and cumulative patency rates were higher in the AVF-used group than in the AVF-not used group (49.4% vs. 10.4%, p=0.001 and 81.8% vs. 33.6%, p=0.02, respectively). On multivariate survival analysis, only diabetes mellitus was associated with non-use of the AVF (hazard ratio 0.14; 95% confidence interval 0.01-1.34).Within the first year of AVF creation, 9.7% of patients had died. No mortalities were observed within the study period in the AVF-used group. Conclusion: Creation and maintenance of AVFs in octogenarians is time consuming and many AVFs created will not be utilized. AVFs should only be created in healthier patients with a longer life expectancy.
Vascular surgery; Fistula; Haemodialysis; Renal failure
Faraj J, Daneshmand A, Sandford M, Wong J, Keung Leong BD, Sannasi VV, et al. Vascular Access Outcomes in the Elderly Renal Failure Population: The VOERP Study. Clin Surg. 2019; 4: 2539.