Bessias Nikolaos, Paraskevas Kosmas I, Tziviskou Effie, Andrikopoulos Vassilios
Department of Vascular Surgery, "Red Cross" Hospital, 24, Papagou Street, N. Iraklio, Athens, 14122, Greece.
Int Urol Nephrol. 2008;40(4):1133-42. doi: 10.1007/s11255-008-9464-2. Epub 2008 Sep 16.
During the last few years, the number of elderly patients with end-stage renal disease (ESRD) has been increasing worldwide. Establishment of a viable vascular access is of primary importance in these patients. This review discusses the advantages and disadvantages of the available vascular access modalities [namely arteriovenous (AV) fistulae, AV grafts, and central venous catheters (CVCs)] in elderly ESRD patients. AV fistulae seem to be superior when compared with other vascular access alternatives with respect to patency, morbidity and mortality rates. On the other hand, due to the age-related advanced atherosclerosis in the elderly, higher failure rates for AV fistulae in this age group have been described. Two controversial issues, namely the higher infection and thrombosis rates in elderly ESRD patients, are also discussed. Current evidence suggests that old age should not comprise a drawback when selecting the appropriate vascular access modality (AV fistula, AV graft or CVC) for the performance of hemodialysis. The possible vascular access options in elderly ESRD patients should not be different from younger individuals.
在过去几年中，全球终末期肾病（ESRD）老年患者的数量一直在增加。建立可行的血管通路对这些患者至关重要。本综述讨论了老年ESRD患者中可用血管通路方式[即动静脉（AV）内瘘、AV移植物和中心静脉导管（CVC）]的优缺点。与其他血管通路选择相比，AV内瘘在通畅率、发病率和死亡率方面似乎更具优势。另一方面，由于老年人与年龄相关的晚期动脉粥样硬化，该年龄组AV内瘘的失败率较高。还讨论了两个有争议的问题，即老年ESRD患者较高的感染率和血栓形成率。目前的证据表明，在为血液透析选择合适的血管通路方式（AV内瘘、AV移植物或CVC）时，年龄不应成为一个不利因素。老年ESRD患者可能的血管通路选择应与年轻个体无异。
