American Journal of Kidney Diseases
Volume 42, Issue 2 , Page 428, August 2003

Venous access: are women equal?

  • David A Goodkin, MD

      Affiliations

    • University Renal Research and Education Association (URREA), Ann Arbor, Michigan, USA
    • ,
  • Friedrich K Port, MS, MD

      Affiliations

    • University Renal Research and Education Association (URREA), Ann Arbor, Michigan, USA

Article Outline

 

To the Editor:

Caplin et al1 retrospectively analyze the results of preoperative vascular mapping versus vascular access outcomes among 192 patients and conclude that women have adequate vasculature for placement of arteriovenous fistulae. This conclusion is based on the finding that there was no significant difference in vein size between men and women. However, it is important to note that Table 2 of their article shows that mean arterial diameters were 0.1 to 0.5 mm greater among men than among women at 11 of 12 anatomic sites in the arms, reaching statistical significance at 3 sites. The limited sample size likely precluded statistical significance at additional sites. Even small differences in arterial diameter can profoundly affect blood flow and fistula maturation, because flow in a tube is proportional to the fourth power of the radius (Poiseuille’s Law). Indeed, the smaller size of women is believed to explain increased graft occlusion2 and mortality,3 compared with men, following coronary artery bypass surgery. Konner et al4 suggest that fistulae can be created successfully even for female diabetics, but they emphasize that the arterial inflow is the key and recommend fistula placement near the elbow in the presence of small or calcified vessels.

It is encouraging to note that Caplin et al1 successfully placed 87 fistulae among 140 patients and there was no difference in prevalence of fistulae between the sexes. Meticulous surgical planning and execution lead to good results. However, the data showing differences in arterial size may explain, in part, the more commonly reported outcome that fistulae are more prevalent among male hemodialysis patients in the United States.

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References 

  1. Caplin N, Sedlacek M, Teodorescu V, Falk A, Uribarri J. Venous access (Women are equal). Am J Kidney Dis. 2003;41:429–432
  2. Eritsland J, Arnesen H, Fjeld NB, Gronseth K, Abdelnoor M. Risk factors for graft occlusion after coronary artery bypass grafting. Scand J Thorac Cardiovasc Surg. 1995;29:63–69
  3. Loop FD, Golding LR, Macmillan JP, Cosgrove DM, Lytle BW, Sheldon WC. Coronary artery surgery in women compared with men (Analyses of risks and long-term results). J Am Coll Cardiol. 1983;1:383–390
  4. Konner K, Hulbert-Shearon T, Roys E, Port FK. Tailoring the initial vascular access for dialysis patients. Kidney Int. 2002;62:329–338

PII: S0272-6386(03)00677-2

doi:10.1016/S0272-6386(03)00677-2

American Journal of Kidney Diseases
Volume 42, Issue 2 , Page 428, August 2003

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