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Arteriovenous Fistula Maturation in an Elderly Population
Beatriz V. Leong, MD, Sarah M. Wartman, MD, Wilson C. Kwon, MS, Sung W. Ham, MD, Sukgu Han, MD, MS, Karen Woo, MD, MS, Fred A. Weaver, MD, MMM, Vincent L. Rowe, MD.
USC, Los Angeles, CA, USA.
Objective: Arteriovenous fistula (AVF) maturation is a challenge investigated by many, with several factors identified hindering maturation. Specifically, AVF placement in elderly patients has been a recent point of contention given higher failure rates and increased central venous catheter dependence. Our aim with this study is to document our experience with AVF maturation in elderly patients, and determine what, if any, factors contribute to fistula maturation.
Methods: After IRB approval, a retrospective review was performed on a prospectively collected fistula database containing all AVF created between March 2010 and December 2014. All patients aged sixty or older at the time of surgery were identified and data including demographics, comorbidities, and maturation information were collected. Analysis was done using ANOVA testing in SPSS.
Results: 112 AVF were created in 104 patients, the mean age was 67, 60 were female and 52 male. There were 31 radiocephalic (RC), 58 brachiocephalic (BC) and 23 basilic vein transpositions (BVT). 16.9% (19) of fistulas failed to mature (4 RC, 12 BC, 3 BVT). For the remaining 93 AVF, the mean time to maturation was 87 days (median 63, range 34-342) (88 RC, 77 BC, 108 BVT). A maturation cutoff of 10 weeks was selected based on our median, at which time 50 (45%) AVF had matured. Delayed maturation (defined as maturation occurring beyond 10 weeks) occurred in an additional 30 cases. 71% of all AVF created had matured by 20 weeks. For patients aged 60-65 the mean maturation time was 90 days, 72 days for 66-75 and 113 days in those >75. Univariate analysis demonstrated no statistically significant variables contributing to maturation.
Conclusions: In this cohort of patients we demonstrate a maturation of 45% of all AVF created by 10 weeks and additional delayed maturation up to 71% by 20 weeks. Both having a BVT and those aged >75 tended to have longer maturation times, but larger sample groups within these populations are needed for significant comparison. While this study demonstrates maturation in elderly is in fact prolonged, placing all type fistulas with careful venous and arterial examination, is an acceptable and safe form of permanent dialysis access.
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