| Theme | Reconsidering dialysis initiation for the elderly | |
|---|---|---|
| Title | Basic issues concerning vascular access construction and repair for maintenance hemodialysis in elderly patients | |
| Publish Date | 2016/01 | |
| Author | Kentaro Okubo | Vascular Access Treatment Center, Nagoya Kyoritsu Hospital |
| Author | Takashi Sato | Vascular Access Treatment Center, Nagoya Kyoritsu Hospital |
| Author | Tamotsu Tojimbara | Department of Transplant Surgery, International University of Health and Welfare, Atami Hospital |
| [ Summary ] | The increasing number of elderly patients receiving hemodialysis therapy has created some issues related to vascular access (VA) construction and maintenance. Elderly patients have various complications, including thin skin, heart failure, destruction and calcification of vessels, malnutrition, and low activity levels, leading to difficulties with VA surgery and higher failure rates during maintenance dialysis. Although arteriovenous fistula (AVF) in the forearm using the radial artery are the preferred form of VA associated with lower incidence of morbidity and mortality, there are various aspects regarding materials and configuration for artificial grafts in addition to the VA site. In some cases with severe arterial calcification, a softening procedure, namely, gentle crushing of the calcified part using tweezers, softens the vessel wall adequately to create an AVF. Graft insertion requires a design that allows easy puncture and repair, without putting a burden on the skin and heart. The grafts and fistulae induce cardiac loads, and patients may develop heart failure, especially elderly patients with impaired cardiac function. Superficialization of an artery or a cuffed central catheter (VA without fistula) is recommended in patients with low left ventricular ejection fractions of less than 30 %. It is necessary to understand the overall status of elderly patients and to devise appropriate VA construction methods. |
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