Venous access: women are equal.
BACKGROUND
Arteriovenous fistulae (AVFs) are the preferred method of vascular access for hemodialysis patients; however, the current rate of AVF placement is only 25% to 30% in the United States. This prevalence is even smaller among women and attributed to their perceived inadequate vasculature. This commonly held view that women have less adequate vasculature for AVF placement than men has not been shown objectively in the literature.


METHODS
To determine a difference in vasculature between the sexes, we retrospectively analyzed data on preoperative vascular mapping in 192 patients. During a 2-year period, vascular mapping of the upper extremities was routinely performed using duplex ultrasound in all patients requiring vascular access in our institution.


RESULTS
One hundred six of these 192 patients were women, and 86 were men. There was no significant difference in vein size between men and women at any of the sites measured. A total of 87 fistulae were placed in 140 patients, 49% in women and 51% in men (P = 0.16). Prevalences of AVFs were 57% and 68% (P = 0.2) in women and men, respectively. Percentages of fistulae used at the initiation of hemodialysis therapy were 72% in women and 77% in men (P = 0.57).


CONCLUSIONS
These data support the view that women have adequate vasculature for the placement of AVFs compared with men. We cannot explain the different outcomes found in other studies; however, we suggest that the differences are caused by physician practice patterns, not anatomic differences between men and women.
Caplin
Nina
N
Departments of Medicine, Surgery, and Radiology, Mount Sinai School of Medicine, New York, NY, USA. ninacaplin@aol.com
Sedlacek
Martin
M
Teodorescu
Victoria
V
Falk
Abigail
A
Uribarri
Jaime
J
D001166:Arteriovenous Shunt, Surgical / Q000379:methods / Q000706:statistics & numerical data*; D018780:Body Surface Potential Mapping / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011300:Preoperative Care / Q000379:methods / Q000706:statistics & numerical data; D006435:Renal Dialysis / Q000379:methods; D012189:Retrospective Studies; D012727:Sex Characteristics; D018616:Ultrasonography, Doppler, Duplex / Q000706:statistics & numerical data; D014481:United States; D014680:Veins / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery