Program Book - Keck School of Medicine of USC - University of ...

hemodialysis. In North America the life expectancy of the individual reaching 80 yearsold is another 7 years of life (a personally depressing statistic), but for the end stagerenal patient this drops to less than 18 months. Given this limited life expectancy andweighing up other risk factors, many elderly patients are best served with a simpletunneled catheter.A last consideration is the use of a lower extremity AV graft positioned from a superficialfemoral artery to the saphenous vein in female patients who have very small upperextremity arteries and veins. Although patency rates are good for this access, infectionrates are higher because of the proximity to contaminated areas. It should be avoided inincontinent patients.The general concepts of autogenous AVF before graft, distal vessels first, upper ratherthan lower extremity, and avoidance of percutaneous catheters are all sound, but ineach instance exceptions to the guidelines may better meet the patient’s needs.References1. KDOQI ( 2006) Vascular Access Guidelines AM J Kidney Disease(2006;48:S177-322)2. Society for Vascular Surgery Practice Guidelines J Vas Surg (2008;48:S1-80)3. Wilson, SE. Vascular Access: Principles and Practice. 5 th edition. Lippincott,Williams and Wilkins 200965