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Worse Arteriovenous Fistula Outcomes In Females: Impact Of Vein Size, Maturation Procedures, And Anatomic Location
Leon Min, BSE1, Hind Anan, MD
2, Mohamed Ali Jawad-Makki, BS
1, Lindsey Haga, MD
2, Theodore Yuo, MD
2.
1University of Pittsburgh School of Medicine, Pittsburgh, PA, USA,
2University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Objective: Sex differences in vascular disease have increasingly been recognized as an important area of research in recent years. While arteriovenous fistula (AVF) is the preferred form of vascular access, it may not be the best option for all patients. The objective of this study is to compare AVF outcomes between males and females.
Methods: A retrospective review of patients who underwent AVF creations between 2019 and 2022 at a multihospital healthcare system was conducted. Cases were identified using the local Vascular Quality Initiative database and supplemented by chart review. Primary outcomes were unassisted maturation, defined as maturation without any intervention, and overall maturation, defined as maturation with or without intervention.
Results: A total of 555 patients undergoing surgical upper extremity AVF creation were included, with 221 (39.8%) being females and 334 (60.2%) males. Both groups were comparable in terms of their comorbidities (Table 1). There was no difference in history of previous AV access (females:19.9%; males:19.4%; p=0.88). Females had a smaller mean vein diameter (3.4±1.3 vs 3.7±1.5 mm; p=0.03) and were more likely to receive upper arm fistula (84.4% vs 69.9%; p<0.001). They had significantly worse unassisted maturation rate (32.1% vs 40.4%; p=0.048). However, the overall maturation rate was similar (females: 66.1%; males:69.8%; p=0.36). Females required significantly more interventions prior to maturation (mean:0.89±0.97 vs 0.67±0.05; p=0.005). On logistic regression, female sex (aOR: 0.58; 95%CI: 0.37-0.87; p=0.01) and history of previous access (aOR: 0.35; 95%CI: 0.18-0.67; p=0.001) were predictors of unassisted maturation failure while vein diameter (aOR: 1.1; 95%CI:0.94-1.2; p=0.49), forearm vs. upper arm location (p=0.13), and black race (aOR: 0.85, 95%CI: 56-1.3; p=0.46) were not. At 1- and 2-year follow-up, females were more likely to be using tunneled dialysis catheter (TDC) as an access (1-year:26.4% vs 16.4% p=0.016; 2-years: 19.2% vs 9.6%, p=0.026).
Conclusion: Compared to males, females have smaller veins and are more likely to undergo upper arm AVF creation, with associated worse unassisted maturation rates. Females required more interventions to obtain similar overall maturation rates. At 1-and 2-year follow-up, females were more likely to require TDC. These findings highlight the need for further research into sex-specific mechanisms affecting AVF outcomes.
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