Lessons from 494 permanent accesses in 348 haemodialysis patients older than 65 years of age: 29 years of experience.

Currently, patients older than 65 years of age constitute more than 42% of all new enrolments for dialytic treatment in the USA and Italy. Most of these patients are treated by in-centre haemodialysis (HD), with problems connected to vascular access. Personal experience of 494 new vascular accesses in 348 'difficult' HD-patients older than 65 years over 29 years showed the best results from 221 elbow fistulas in comparison with 32 forearm fistulas (78% vs 57.2% at 3 years; P < 0.05). Among various vascular substitutes, the homologous saphenous vein (HSV) graft, alone or mixed (MX) gave the best secondary patency in comparison with other organic-semiorganic (OSO) or synthetic graft (SYN) angioaccesses with values of 59.4% for HSV, 66.3% for MX, 21.9% for OSO, and 38.6% for SYN grafts, respectively at 3 years.