• 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


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. 


Download data is not yet available.


1. Hemodialysis acess. (2015). National Kidney Foundation. Retirado em Maio 2016, de

2. Rosenberg M. (2016, 24 de Fevereiro) Overview of the management of chronic kidney disease in adults. Retirado em Maio de 2016, de

3. Lazarides, M; Georgiadis, G; Antoniou, G. et al.“A meta-analysis of dialysis access outcome in elderly patients”, Journal or Vascular Surgery, Vol 45, no 2; 420-426.

4. Tordoir JHM, Van Der Sande FM, De Haan MW. Current topics on vascular access for hemodialysis. Minerva Urol Nefrol 2004;56:23-35.

5. Rodriguez J, Lopez J, Cléries M, Vela E, and renal registry committee. Vascular access for hemodialysis. An epidemiologic study of the Catalan renal registry. Nephrol Dial Transplant 1999;14:1651-7.

6. Berardinelli L, Vegeto A. Lessons from 494 permanent accesses in 348 hemodialysis patients older than 65 years of age: 29 years of experience. Nephrology, Dialysis, Transplantation. 1998. 13; 7:73-7.

7. Lok CE, Oliver MJ, Su J, et al. Arteriovenous fistula outcomes in the era of the elderly dialysis population. Kidney Int. 2005; 67(6):2462–69.

8. Ridao-Cano N, Polo JR, Polo J, et al. Vascular access for dialysis in the elderly. Blood Purif 2002;20:563-8.

9. Staramos DN, Lazarides MK, Tzilalis VD,et al. Patency of autologous and prosthetic arteriovenous fistulas in elderly patients. Eur J Surg 2000;166:777-81.

10. Wolowczyk L, Williams AJ, Donovan KL, et al. The snuffbox arteriovenous fistula for vascular access. Eur J Vasc Endovasc Surg 2000;19:70-6.

11. Lazarides MK, Iatrou CE, Karanikas ID, et al. Factors affecting the lifespan of autologous and synthetic arteriovenous access routes for haemodialysis. Eur J Surg 1996;162:297-301.

12. Gomez Campdera FJ, Polo JR, Sanabia J, Tejedor A. First-choice vascular access in patients over 65 years of age starting dialysis. Nephron 1996;73:342-3.

13. Leapman SB, Boyle M, Pescovitz MD, et al. The arteriovenous fistula for hemodialysis access: gold standard or archaic relic? Am Surg 1996;62:652-7.

14. Schwenger V, Morath C, Hofmann A, et al. Late referral - a major cause of poor outcome in the very elderly dialysis patient. Nephrol Dial Transplant 2006;21:962-7.

15. Moist, L; Lok, Charmaine; Vachharajani, T. et al. “Optimal Vascular Access in the Elderly Patient”, Semin Dial. 2012; 25(6): 640-8.

16. Selcuk Baktiroglu, “Vascular access in the elderly: A venous access is always better”, Vascular News, Charing Cross Special Edition, March 2016, 32

17. Ethier J, Mendelssohn DC, Elder SJ, et al. Vascular access use and outcomes: an international perspective from the Dialysis Outcomes and Practice Patterns Study. Nephrol Dial Transplant. 2008; 23(10):3219–26.

18. Pisoni RL, Arrington CJ, Albert JM, et al. Facility hemodialysis vascular access use and mortality in countries participating in DOPPS: an instrumental variable analysis. Am J Kidney Dis. 2009; 53(3):475–91.

19. Lok CE, Allon M, Moist L, et al. Risk equation determining unsuccessful cannulation events and failure to maturation in arteriovenous fistulas (REDUCE FTM I). J Am Soc Nephrol. 2006; 17(11):3204–12.

20. Golledge J, Smith CJ, Emery J. et al. Outcome of primary radiocephalic fistula for haemodialysis. Br J Surg. 1999; 86(2):211–16.

21. Burt CG, Little JA, Mosquera DA. The effect of age on radiocephalic fistula patency. J Vasc Access. 2001; 2(3):110–13

22. Johnson CP. Peroperative and intraoperative predictors of vascular access outcome. Vascular Access for Hemodialysis. 2002; VIII:143–156.

23. Kawecka A, Debska-Slizien A, Prajs J, et al. Remarks on surgical strategy in creating vascular access for hemodialysis: 18 years of one center’s experience. Ann Vasc Surg. 2005; 19(4):590–98.

24. Swindlehurst N, Swindlehurst A, Lumgair H, et al. Vascular access for hemodialysis in the elderly. J Vasc Surg. 2011; 53(4):1039–43

25. Zamani P, Kaufman J, Kinlay S. Ischemic steal syndrome following arm arteriovenous fistula for hemodialysis. Vasc Med. 2009; 14(4):371–6

26. Moist LM, Trpeski L, Na Y, Lok CE. Increased hemodialysis catheter use in Canada and associated mortality risk: data from the Canadian Organ Replacement Registry 2001–2004. Clin J Am Soc Nephrol. 2008; 3(6):1726–32.

27. Polkinghorne KR, McDonald SP, Atkins RC, et al. Vascular access and all-cause mortality: a propensity score analysis. J Am Soc Nephrol. 2004; 15(2):477–86

28. Astor BC, Eustace JA, Powe NR, et al. Type of vascular access and survival among incident hemodialysis patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) Study. J Am Soc Nephrol. 2005; 16(5):1449–55.

29. Ocak G, Halbesma N, le CS, Hoogeveen EK, et al. Haemodialysis catheters increase mortality as compared to arteriovenous accesses especially in elderly patients. Nephrol Dial Transplant. 2011; 26(8):2611–17.

30. Rooijens PPG, Tordoir JHM, Stijnen T. et al. Radiocephalic wrist arteriovenous fistula for hemodialysis: Meta-analysis indicates a high primary failure rate. Eur J Vasc Endovasc Surg 2004;28:583-9.
Original Article