Claudeanos Kevin T, Hudgins Jonathan, Keahey Gail, Cull David L, Carsten Christopher G
Department of Surgery, Greenville Health System, Greenville, SC.
Department of Surgery, Greenville Health System, Greenville, SC.
Ann Vasc Surg. 2015 Jan;29(1):98-102. doi: 10.1016/j.avsg.2014.10.002. Epub 2014 Oct 29.
The incidence of end-stage renal disease is increasing most rapidly in patients aged older than 75 years. Meanwhile, their 5-year survival rate remains the lowest of any dialysis cohort. The purpose of this study was to evaluate the benefit of arteriovenous fistula (AVF) construction in octogenarians, as the data regarding the effects of age on fistula success are conflicting.
Using our hemodialysis database, we performed a retrospective review of all AVFs placed between 1 November, 2007, and 17 July, 2013, in patients aged 80 years or older. Patient demographics, presence of catheters, time to first fistula use, fistula interventions, fistula patency, and time to patient death were all evaluated.
We placed 32 fistulas in 31 patients. Our average patient was 82-year-old, men (75%) and Caucasian (71%). Three patients were excluded, as they never required dialysis. One patient required 2 fistulas; the second fistula was excluded from analysis. Of the remaining 28 patients, 22 (78%) were used for hemodialysis and 19 (68%) required catheter-based dialysis before fistula use. The mean length of catheter use was 166 days, and the median time to first fistula use was 109 days. Primary functional patency was 51% at year 1 and 38% at year 2, respectively. Secondary patency was 75% at year 1 and year 2. Of the 22 patients, 17 (77%) required intervention to achieve or maintain patency. The median time to death was 26 months.
With substantial effort, successful fistula utilization can be achieved in an extremely elderly patient population. Our patients experienced significant catheter utilization and over 3 quarters required secondary interventions to achieve or maintain fistula utilization. Given this group's limited survival and the fact that 21% of their survival time was spent dialyzing with a catheter, the benefit of a functioning fistula to a patient older than 80 years can be questioned.
终末期肾病的发病率在75岁以上患者中增长最为迅速。与此同时，他们的5年生存率在所有透析队列中仍然是最低的。本研究的目的是评估在八旬老人中建立动静脉内瘘（AVF）的益处，因为关于年龄对瘘管成功影响的数据存在矛盾。
利用我们的血液透析数据库，我们对2007年11月1日至2013年7月17日期间为80岁及以上患者建立的所有AVF进行了回顾性研究。对患者的人口统计学特征、导管的存在情况、首次使用瘘管的时间、瘘管干预措施、瘘管通畅情况以及患者死亡时间进行了评估。
我们为31例患者建立了32个瘘管。我们的患者平均年龄为82岁，男性（75%），白种人（71%）。3例患者被排除，因为他们从未需要透析。1例患者需要2个瘘管；第二个瘘管被排除在分析之外。在其余28例患者中，22例（78%）用于血液透析，19例（68%）在瘘管使用前需要基于导管的透析。导管使用的平均时长为166天，首次使用瘘管的中位时间为109天。1年时的初级功能通畅率分别为51%，2年时为38%。1年和2年时的次级通畅率为75%。在22例患者中，17例（77%）需要干预以实现或维持通畅。中位死亡时间为26个月。
经过大量努力，可以在极高龄患者群体中成功利用瘘管。我们的患者导管使用率很高，超过四分之三的患者需要二次干预以实现或维持瘘管的使用。鉴于该群体有限的生存期以及他们21%的生存时间是通过导管进行透析的，对于80岁以上患者而言，一个功能正常的瘘管的益处可能受到质疑。
