Patency of Autologous and Prosthetic Arteriovenous Fistulas in Elderly Patients

OBJECTIVE: To compare the patency of autologous and graft-bridging (prosthetic) arteriovenous (AV) fistulas in patients 70 years of age or more. DESIGN: Non-randomised comparative study. SETTING: University hospital, Greece. PATIENTS: 114 patients aged 70 years or more (mean 78) who required 135 consecutive angioaccess procedures during the 8-year period January 1990-December 1997. INTERVENTIONS: 68 autologous and 67 prosthetic procedures, 64 of the prosthetic procedures being proximal brachioaxillary AV arm grafts. MAIN OUTCOME MEASURES: Primary and secondary cumulative patency rates and cumulative survival. RESULTS: Life table analysis showed that the 3-year secondary patency (medium term patency) was significantly superior in the prosthetic group (58% compared with 44%, p = 0.04). Cumulative survival at 3-years was 21%. CONCLUSIONS: A proximal brachioaxillary prosthetic AV graft is a good alternative as initial primary access in elderly patients who are not suitable for an autologous proximal AV fistula. At this age long term patency and conservation of proximal access sites are of minimum importance because of their limited life expectancy.