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  1. 1. For Old or Young Dialysis Patients, AV Fistulas Remain Pure Gold Andrew R. Forauer, MD Michael Bazylewicz, BS Kristine A. Pattin, BS Interventional Radiology Dartmouth-Hitchcock Medical Center Lebanon, NH
  2. 2. Scope of the problem • End-stage kidney disease effects hundreds of thousands of U.S. patients • Approximately 400,000 require hemodialysis • 20 % of those on dialysis are age 75 or older • That’s 1 out of 5 patients !
  3. 3. When your kidneys don’t work • Kidneys filter the blood & remove harmful substances • When they don’t work properly, the toxins accumulate, & patients become ill • They will require : – an artificial form of blood filtering (=DIALYSIS) – kidney transplant
  4. 4. Dialysis 101 • This requires removing blood, filtering it, and returning it the patient
  5. 5. Dialysis 101 • This filtering can be accomplished by creating a connection between an artery & a vein, typically in the arm. • Termed an ARTERIOVENOUS (AV) access • The preferred method uses the patient’s own veins to create this connection (=an AV fistula)
  6. 6. Connection of the vein to the artery The flow of blood is indicated by the arrows () from the artery, into the fistula & back to the heart. artery Fistula (vein) Left upper arm AV fistula
  7. 7. • Unfortunately, narrowings develop in these AV fistulas over time • Reducing blood flow through them • Making dialysis less efficient • Requires a medical procedure to correct • Interventional Radiologists can identify these narrowings, position a balloon catheter , & dilate them (Angioplasty)
  8. 8. Misconception: The elderly patient does not do well when they require dialysis • Why wouldn’t the way we provide dialysis be the same for younger vs. older patients? • The elderly may have more chronic medical conditions & be receiving more medications • But do these factors effect the patient’s AV access ?
  9. 9. Goals • Does balloon dilation (angioplasty) of dialysis fistulas in elderly patients work the same, better, or worse compared to younger patients ? • Are the patency rates (how long these fistulas remained open) in older patients to a younger patients the same ?
  10. 10. Comparing the two groups Patients aged 75 yrs & older Younger patients (age 40 – 60 yrs) Number of patients 38 36 Average age (years) 80.0 52.9 Time on dialysis (days) 120 360
  11. 11. Co-existing medical conditions Patients aged 75 yrs & older Younger patients (age 40 – 60 yrs) Diabetes 17 24 High blood pressure 30 27 Heart disease or atherosclerosis 28 15 Heart function (% EF) 52% 63%
  12. 12. Our Findings… • Heart or vascular disease, the time spent on dialysis & medications had no influence on two important aspects: 1. how long the access stayed open 2. response to angioplasty to keep them open
  13. 13. How well did angioplasty work in keeping the access open ? • Older patients (75 years & older): – 200.2 days (6.7 months) • Patients age 40 – 60 years: – 211.5 days (7 months) • No significant difference
  14. 14. Summary • Our results support: – creating AV fistulas for dialysis in older patients; this is the preferred route for treatment – the key role Interventional Radiology plays in keeping them open and functioning properly • Older patient age alone should not be viewed as limiting the patient’s access options

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