Comparison of vascular access outcomes in octogenarian patients undergoing hemodialysis

Background: The number of patients aged ⩾80 years with end-stage kidney disease is increasing, making vascular access selection increasingly challenging. Although arteriovenous fistula (AVF) is generally preferred, its advantages over arteriovenous graft (AVG) in very elderly patients remain uncertain. This study compared AVF and AVG outcomes in octogenarian patients undergoing hemodialysis access creation. Methods: We retrospectively analyzed 266 patients ⩾80 years who underwent arteriovenous access creation (AVF, n = 163 and AVG, n = 103). The AVF group was further divided into brachiocephalic fistula (BCF, n = 119) and radiocephalic fistula (RCF, n = 44), while the AVG group included lower-arm grafts ( n = 75) and upper-arm grafts ( n = 28). Maturation and patency outcomes were compared, and Cox regression analysis was performed to identify predictors of primary patency. Results: AVF showed significantly higher 1-year primary patency than AVG (63.6% vs 43.5%, p = 0.012), whereas secondary patency was similar between the two groups (86.6% vs 86.8%, p = 0.99). AVF required a longer time to use than AVG (median 51 vs 41 days, p < 0.001), whereas AVG more frequently required repeated percutaneous transluminal angioplasty (PTA) after access creation. Within the AVF group, BCF showed higher primary patency compared with RCF (69.4% vs 48.8%, p = 0.036), while non-use rates and secondary patency were similar. In multivariable analysis, minimum vein diameter was the only independent predictor of primary patency (HR, 0.37; 95% CI, 0.15–0.92; p = 0.033), with an estimated cutoff value of 3.03 mm. Conclusion: In patients aged ⩾80 years, AVF provides superior primary patency despite longer maturation, whereas repeated interventions enabled AVG to achieve comparable secondary patency. These findings support individualized vascular access selection according to expected maturation and clinical circumstances, with preoperative vein diameter serving as an important factor when considering AVF creation.