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Primary patency of arteriovenous fistulas and biosynthetic grafts: Is there a gender difference?

Loren L. Masterson, MD, MBA, Patricia Pentiak, MD, Mohsen Bannazadeh, MD, Adewunmi Adeyemo, MD, O. William Brown, MD.
William Beaumont Hospital, Royal Oak, MI, USA.

OBJECTIVES: Patients who require long term hemodialysis (HD) typically receive either an arteriovenous fistula (AVF), biosynthetic prosthesis graft(AVG) or tunneled central catheter. AVF are the preferred primary access for patients, and gender differences have been reported in the past in their implementation and use. While studies have shown that AVF have greater patency overall, AVG are implemented in women at a higher rate then men possibly due to concerns over vessel size or early fistula failure. This retrospective study aims to examine the primary patency rates of both AVF and AVG at our institution, and to evaluate any gender differences in their use or function.
METHODS: A retrospective chart review was conducted. All AVF and AVG performed over the previous two years at our institution were included for review. Patient demographics such as cause of end-stage renal disease (ESRD), age at time of procedure and gender were evaluated, as well as primary patency (defined as time until first successful HD treatment). Patency at one year and any complications were also reviewed where data was available.
RESULTS: A total of 132 patients received AVF or AVG in the
study time period. Any patients with inadequate follow-up or without recorded primary patency rates were excluded. A total of 12 AVG and 36 AVF over the previous 2 year time period were qualified. Significantly more women received AVG then men - 75% of AVG studied were performed in women, in comparison to 25% of AVF. The one year patency of all AVG and AVF was 70.0% (standard error of 8.46%), which is consistent with previously reported national patency rates. When comparing primary patency of AVG and AVF, there was no statistical difference demonstrated (p value 0.64). When evaluating complications, complication rates were similar in women who received AVF versus AVG (37.5% versus 38.0%).
CONCLUSIONS: At our institution, there was no significant difference in patency or complications between AVG and AVF over a 1 year time period in female patients. While long term follow up is needed, AVG are still a viable option for women that do not qualify for an AVF. Future studies include a review of pre-operative evaluation of these patients in comparison to long term patency.

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