Radiocephalic and brachiocephalic arteriovenous fistula outcomes in the elderly

Weale, Andy R.; Bevis, Paul; Neary, William D.; Boyes, Simon; Morgan, Justin; Lear, P. A.; Mitchell, David C.

doi:10.1016/j.jvs.2007.09.046

Cited by 95 publications

(72 citation statements)

References 36 publications

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“…In addition to the above variables, a further two statistically non-significant variables, i.e. dialysis [22,23] (ever versus never) and eGFR [24], were added to the model due to their possible clinical association with the maturation of AVF as suggested by the vascular surgeons.…”

Section: Univariable Associationsmentioning

confidence: 99%

Development of prognostic model for fistula maturation in patients with advanced renal failure

et al. 2018

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Background: This study aimed to explore the role of patient's characteristic and haematological factors as predictive on the maturation of arteriovenous fistulae in patients who underwent vascular access surgery at the Royal Infirmary of Edinburgh. Methods: Retrospective data from 300 patients who had undergone fistula creation between February 2007 and October 2010 was examined. A predictive logistic regression model was developed using the backward stepwise procedure. Model performance, discrimination and calibration, was assessed using the receiver operating characteristics (ROC) curve and Hosmer and Lemeshow goodness of fit test. Results: Three variables were identified which independently influenced fistula maturation. Males were twice as likely to undergo fistula maturation, compared to that of females (odds ratio (OR) 0.514; 95% confidence interval (CI) 0.308-0.857), patients with no evidence of peripheral vascular disease (PVD) were three times more likely to mature their fistula (OR 3.140; 95% CI 1.596-6.177) and a pre-operative vein diameter > 2.5 mm resulted in a fivefold increase in fistula maturation compared to a vein size less than 2.5 mm (OR 4.532; 95% CI 2.063-9.958). The model for fistula maturation had fair discrimination as indicated by the area under the ROC curve (0.68; 95% CI 0.615-0. 738) but good calibration indicated by Hosmer and Lemeshow test (p = 0.79). Conclusion: Gender, PVD and vein size are independent predictors of arteriovenous fistula maturation. The clinical utility of these risk equation in the maturation of arteriovenous fistulae requires further validation in the newly treated patients.

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Section: Univariable Associationsmentioning

confidence: 99%

Development of prognostic model for fistula maturation in patients with advanced renal failure

et al. 2018

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“…(13) In this cohort a higher number of radiocephalic AVFs (46.3%) were formed than brachiocephalic AVFs (40.3%) and first stage brachiobasilic AVFs (7.5%). This range of AVFs formed is reflective of a larger retrospective cohort published by Weale and colleagues (14) where more radiocephalic (53.9%) AVFs were formed than brachiocephalic AVFs (46.1%).…”

Section: Discussionmentioning

confidence: 56%

Patient Survival following Arteriovenous Fistula Formation

et al. 2015

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Type of article for submission Original manuscript ABSTRACT Purpose:Efforts to promote arteriovenous fistulas (AVFs) have been successful in increasing the prevalence of AVF use as the primary vascular access for haemodialysis HD.Sustained preference for AVF use may not be the most appropriate vascular access choice for all patient groups. Arteriovenous grafts (AVGs) offer advantages of earlier use and lower primary failure rates compared to AVFs so may be preferable for patients where short term vascular access is needed. This study was designed to assess comparative mortality in different age groups following AVF formation. Methods:A prospective cohort of patients having AVF creation was recruited. Patients were subdivided into three age groups; Group A: < 50 years; Group B: 50-74 years and Group C: 75 years. Survival curves and Cox regression analysis was performed on each of these groups. Results:One hundred and thirty-four patients (n=134) were recruited into the study. The prevalence of diabetes increased significantly with age. As expected, mortality was higher in older age groups (log rank (mantel cox) 19.227; p = 0.0001). Mortality rates at one year were 0% in group A, 12.5% in group B and 29.1% in group C. Medium term mortality at four years was 7.9% in group A, 39.1% in group B and 54.8%% in group C. Conclusions:We found a significantly higher mortality rate in patients ≥75 years in comparison to those <75 years. The choice of vascular access modality should be tailored to the individual with particular reference to the patient's expected survival.

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“…National clinical guidelines and recommendations are not age specific and do not address the difficulty of VA placement and maintenance in elderly patients despite the marked differences in comorbidities and the natural history of chronic kidney disease in elderly patients compared to non-elderly or young patients [11] . Increased age is generally associated with maturation failure in AVF, and this risk may be more than doubled in the elderly population [12][13][14] . Although AVG requires more interventions to maintain patency, AVF requires more interventions for achieving maturation [15] .…”

Section: Discussionmentioning

confidence: 99%

Comparison of Outcomes with Arteriovenous Fistula and Arteriovenous Graft for Vascular Access in Hemodialysis: A Prospective Cohort Study

Park

Kim

et al. 2016

Am J Nephrol

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Background: Poor vessel quality and limited life expectancy in the elderly may make arteriovenous fistula (AVF) less ideal than arteriovenous graft (AVG) or catheter for vascular access (VA) in hemodialysis (HD). Methods: A total of 946 adult incident HD patients from clinical research center registry for end-stage renal disease prospective cohort in South Korea were analyzed for outcomes with AVF and AVG. Results: Overall, AVF was associated with better patient survival only in male (p < 0.001) and diabetic (p = 0.004) patients, although it was superior to AVG in access patency, regardless of diabetes mellitus status and gender. AVG (vs. AVF; hazard ratio (HR) 2.282; 95% CI 1.071-4.861; p = 0.032) was associated with poor patient survival. In elderly patients (≥65 years), AVF was associated with survival benefit only in male (p < 0.001) and diabetic (p = 0.04) patients, and with better access patency only in female (p = 0.05) and diabetic (p = 0.04) patients. AVG (vs. AVF; HR 3.158; 95% CI 1.080-9.238; p = 0.036) was associated with poor patient survival. In septuagenarian patients, AVF was associated only with survival benefit (p = 0.01) and there was no advantage in access patency (p = 0.12). However, AVF was superior to AVG in both access patency (p = 0.001) and patient survival (p = 0.03) even with propensity matching. Conclusion: AVF is the more desirable VA and its survival benefits warrant its consideration in septuagenarian patients although a prolonged life expectancy is essential to realize the potential benefits of AVF.

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Radiocephalic and brachiocephalic arteriovenous fistula outcomes in the elderly

Abstract: Age did not affect usability, primary or secondary patency of either RCAVFs or BCAVFs. Although patient selection is important, even patients > or =80 years who are considered suitable for surgical placement of access should not be denied a RCAVF solely because of age.

Cited by 95 publications

References 36 publications

Development of prognostic model for fistula maturation in patients with advanced renal failure

Development of prognostic model for fistula maturation in patients with advanced renal failure

Patient Survival following Arteriovenous Fistula Formation

Comparison of Outcomes with Arteriovenous Fistula and Arteriovenous Graft for Vascular Access in Hemodialysis: A Prospective Cohort Study

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