Arteriovenous Grafts Demonstrate Comparable Patency and Faster Maturation Than Basilic Vein Transposition in Octogenarians

OBJECTIVE: Arteriovenous fistulas (AVFs) are preferred for hemodialysis access over arteriovenous grafts (AVGs) due to their better long-term durability and lower infection rates. In the specific population of patients 80 and older, the benefits of AVFs are less clear due to the increased burden of reinterventions and the longer time required for a BVT to mature as compared to an AVG. This study aims to compare patency rates, as well as the time to maturation, between BVT and AVG in patients over 80 years old. METHODS: A retrospective review was performed of patients aged ≥80 years who underwent hemodialysis access creation between 2019 and 2024. The cohort included 211 accesses (140 AVGs and 71 BVTs) performed by 14 surgeons across 8 hospitals. Patients without any follow-up (14 AVGs, 9 BVTs) were excluded from analyses. Primary endpoints included primary, primary-assisted, and secondary patency, as well as time to maturation. Kaplan-Meier survival analysis was used to estimate patency outcomes. Postoperative complications, thrombosis, and the number of reinterventions were also collected. RESULTS: There were 140 AVGs and 71 BVTs. Overall complication rates were similar between groups, although patients receiving AVGs were more likely to have had prior access (60% vs 32%, p = 0.0002). Kaplan-Meier analysis demonstrated no statistically significant difference in primary patency between AVGs and BVTs (log-rank p = .567). Primary-assisted patency was significant, with a median of 1015 days compared to 280 days for AVGs (log-rank p < .001). On multivariable Cox regression at 1 year, BVT remained independently associated with improved primary-assisted patency (aHR 0.26, 95% CI: 0.11-0.59, p = .001). Secondary patency did not differ significantly between groups (log-rank p = .563). The median time to maturation was shorter for AVGs (26 days) compared to BVTs (33 days) (p = 0.0017). CONCLUSIONS: In patients aged 80 years or older, arteriovenous grafts (AVGs) demonstrated secondary patency rates similar to those of autogenous arteriovenous fistulas (BVTs), but with a significantly shorter time to maturation. However, the long-term durability of both access types declined notably, with approximately half of the accesses being abandoned by the third year. These results indicate that for patients aged 80 years or older who lack a suitable cephalic vein, the use of AVGs may offer a significant long-term benefit, avoiding the possible delay in the achievement of mature access. This offers guidance for clinicians to utilize the "Life-Plan" approach outlined by the recent KDOQI guidelines.