Objective To analyze the features of vascular access in the elderly patients receiving maintenance hemodialysis (MHD) (≥ 65 years old) in order to provide experiences for long-term vascular access patency. Methods Clinical data of MHD patients admitted in our department from March 2009 to March 2013 were collected and retrospectively analyzed in this study. According to their age, the patients were divided into the elderly group (≥65 years old, n=116), and the middle-aged group (< 65 years old, n=130). The types, construction and usage of vascular access were analyzed. SPSS statistics 15.0 was used to analyze the data. The measurement data were expressed as mean±standard deviation ([AKx-D]±s), and Student’s t test was employed for the comparison between groups. Enumeration data were expressed as percentage, and inter-group comparison was carried out with Chi-square test. Results The proportion of catheterization was significantly higher in the elderly group than in the middle-aged group (44% vs 10%, P=0.006), and it was more common in female patients regardless of the age. The elderly patients had obviously higher ratio of emergency (19.0% vs 5.4%, P=0.008), and higher prevalence of major comorbidities, such as diabetes, cardiovascular diseases and peripheral vascular diseases. But, the ratios of fistula establishment and catheterization were similar between the elderly complicated with diabetes or peripheral vascular disease (50.7% vs 49.3%, P=0.217). The nutritional status (BMI, hemoglobin and albumin) were significantly worse in the elderly catheterization group (P=0.007, P=0.006, P=0.007). In the elderly groups, there were more fistula established in the elbow than the middle-aged group (8.3% vs 0.9%, P<0.001). The primary patency of fistula was less in the elderly than the middle-aged group (P=0.009), but the cumulative patency was similar between the 2 groups, though with higher rate of interventions (P=0.006). The prevalence of fistula maturation failure was obviously higher in the elderly (10.0% vs 3.5%, P=0.008). There were more patients undergoing tunneled cuffed catheterization in the elderly group (30.4% vs 0.0%, P<0.05). No significant difference was seen in the catheter patency between the 2 groups, but the elderly group had higher incidence of catheter-related infections (21.7% vs 15.3%, P=0.006). Conclusion Compared with the middle-aged MHD patients, the elderly ones have higher prevalence of catheterization and catheter-related infections, but similar patency of catheter. Though they have higher rate of fistula in the elbow, worse patency and fistula maturation, active interventions will obtain better outcomes as in the younger patients.