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• W2075915437 abstract "We read with great interest the article by Weale et al,1Weale A.R. Bevis P. Neary W.D. Boyes S. Morgan J.D. Lear P.A. et al.Radiocephalic and brachiocephalic arteriovenous fistula outcomes in the elderly.J Vasc Surg. 2008; 47: 144-150Abstract Full Text Full Text PDF PubMed Scopus (91) Google Scholar quoting also our meta-analysis bringing up the controversial topic of access selection in the elderly.2Lazarides M.K. Georgiadis G.S. Antoniou G.A. Staramos D.N. A meta-analysis of dialysis access outcome in elderly patients.J Vasc Surg. 2007; 45: 420-426Abstract Full Text Full Text PDF PubMed Scopus (240) Google Scholar We fully agree with their statement that “patients over 65 years of age suitable for any form of surgical access should not automatically be offered a brachial-cephalic arterio-venous fistula (BCAVF) as a first access procedure” and their insistence to use radial-cephalic arteriovenous fistulas (RCAVF) in those patients in whom it appears clinically appropriate. The authors, however, challenged our finding that elderly patients have significant benefit from BCAVF compared with RCAVF in terms of one-year failure rate, commenting that the latter had not been upheld by their data for either the group aged 65 to 79 years or the over 80 group. In an effort to renovate our data, we added in our meta-analysis the data of Weale et al regarding the one-year secondary patency of BCAVF and RCAVF in elderly patients (in both groups; those aged 65 to 79 years or aged over 80). A total of 317 patients over 65 years of age were added (167 out of them underwent RCAVF and 150 BCAVF respectively). The meta-analysis results after adding the relevant data extracted from the article of Weale et al are depicted in the figure. The pooled effect was presented as odds ratio and 95% confidence intervals (OR and 95% CI) representing the odds of failure at one year in the BCAVF group as compared with the RCAVF group. The OR was 0.62 (95% CI 0.46-0.83, fixed effect model) in favor of a BCAVF, indicating that the risk of failure of BCAVFs at one year is significantly less than RCAVFs in elderly patients over 65 years of age, a trend that was also noticed and in the article of Weale et al. We agree that the existing literature where our meta-analysis was based includes only non-randomized studies and therefore the pooled data from those cannot provide level one evidence. However, in elderly patients conservation of proximal access sites are of minimal importance because of their limited life expectancy and more liberal use of proximal access types as the BCAVF is in our view justified; such a choice may also be beneficial in terms of one-year failure rate as was clearly indicated in the pooled results of all the existing studies up to now (Fig). ReplyJournal of Vascular SurgeryVol. 48Issue 1PreviewWe are encouraged that the authors of the recent meta-analysis of arteriovenous fistulas (AVFs) in the elderly agree that patients suitable for radiocephalic fistulas should be offered that procedure, regardless of age.1 Full-Text PDF Open Archive" @default.
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• W2075915437 title "Regarding “Radiocephalic and brachicephalic arteriovenous fistula outcomes in the elderly”" @default.
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• W2075915437 doi "https://doi.org/10.1016/j.jvs.2008.03.053" @default.
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