VASCULAR ACCESSES ON OCTOGENARIAN PATIENTS

  • Marta Reia General Surgery Department, Hospital Doutor José Maria Grande, Portalegre
  • Ana Afonso Vascular Surgery Department, Hospital Garcia de Orta, Almada
  • António Gonzalez Vascular Surgery Department, Hospital Garcia de Orta, Almada
  • Ana Gonçalves Vascular Surgery Department, Hospital Garcia de Orta, Almada
  • Maria José Ferreira Vascular Surgery Department, Hospital Garcia de Orta, Almada
Keywords: arteriovenous fistulae, octogenarian, autologous access

Abstract

Introduction: The vascular access used in hemodialysis patients with chronic renal disease include the arteriovenous fistulae (AVF) (proximal and distal), grafts and central venous catheters. It is a question of debate if there is an advantage or indication to obtain definitive vascular access in patients with advanced age, especially over 80 years. The aim of the article focuses on demonstrating the feasibility and advantages of autologous accesses on octogenarian patients. 

Material and Methods: Retrospective analysis of electronic records of patients undergoing vascular access (AVF proximal, distal and grafts), aged> 79 years. The time period was evaluated from 01/01/2010 to 31/12/2015. 

Results: The sample of six years includes 21 patients. Of the sample, 52% are male and 48% female. The age distribution shows 10 patients (82-84), 5 patients (79-81), 5 patients (85-88) and 1 patient (89-90) years. The analysis of the presence of the cardiovascular risk factors (RF) (diabetes mellitus, smoking and dyslipidemia), of which 35%: 2 RF; 24%: 3RF; 23%: 1RF; 12% none of the considered. Of the total sample, 67% had diabetes mellitus (57% non-insulin-treated and 43% insulin-treated). The evaluation of the functional status of the sample using the Katz scale, showed 3 patients with score 0, 9 patients with score 1, 5 patients with score 2, 2 patients with score 3 and 2 patients with score 4. For the location of the access, 40% distal AVF, 35% proximal AVF and 25% grafts. All patients were first tested with Doppler ultrasound for anatomic definition. From all surgeries, 19% of patients (4 in total) required a new more proximal access. It stands out as complications, one hematoma and two surgical infections. 

Conclusion: This study proved that is possible to achieve permanent vascular access (fistula or graft) in octogenarian patients starting dialysis, and that the functional status is a more important determinant than the chronological age" 

It is recommended an individualized approach, with more liberal use of proximal or prosthetic access, given the shorter life expectancy of patients. 

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Published
2017-05-14
Section
Original Article