Pham Xuan-Binh D, Kim Jerry J, Parrish Aaron B, Tom Cynthia, Ihenachor Ezinne J, Mina David, de Virgilio Christian
Department of Surgery, Harbor-UCLA Medical Center, Torrance, California, USA.
Am Surg. 2016 Oct;82(10):973-976.
Prior studies have shown racial and gender differences with respect to maturation of arteriovenous fistulas. Women and minorities have lower maturation rates for unclear reasons. Small arterial diameter and high brachial artery bifurcation (HBB) are also implicated in reduced maturation rates. We sought to correlate differences in upper extremity arterial anatomy to race and gender. All upper extremity vascular mapping ultrasounds from 2013 to 2014 were retrospectively reviewed. A total of 509 arms in 284 patients were evaluated. Men had significantly higher mean arterial diameters than women at the elbow brachial (4.7 vs 3.9 mm, P < 0.01) and wrist radial arteries (2.1 vs 1.9 mm, P = 0.03). There were 20 (7%) patients with HBB of at least one arm, and 7 (2.5%) patients with bilateral HBB. African-American patients had significantly higher rates of both unilateral HBB (15.9% vs 5.4%, P = 0.02) and bilateral HBBs (9.1% vs 1.3%, P = 0.01). In conclusion, men had significantly larger arteries than women, and African-Americans had a higher rate of HBB than non-African-Americans. Consideration should be given for routine preoperative ultrasound to assess arterial anatomy before arteriovenous fistulas creation, particularly in women and in African-Americans.
先前的研究表明，动静脉内瘘成熟存在种族和性别差异。女性和少数族裔的内瘘成熟率较低，原因不明。动脉直径小和肱动脉高分叉（HBB）也与成熟率降低有关。我们试图将上肢动脉解剖结构的差异与种族和性别联系起来。对2013年至2014年所有上肢血管造影超声进行回顾性分析。共评估了284例患者的509条手臂。男性在肘肱动脉（4.7对3.9mm，P<0.01）和腕桡动脉（2.1对1.9mm，P=0.03）的平均动脉直径显著高于女性。有20例（7%）患者至少有一侧手臂存在HBB，7例（2.5%）患者双侧存在HBB。非裔美国患者单侧HBB（15.9%对5.4%，P=0.02）和双侧HBB（9.1%对1.3%，P=0.01）的发生率均显著更高。总之，男性的动脉明显大于女性，非裔美国人的HBB发生率高于非非裔美国人。在创建动静脉内瘘之前，应考虑常规术前超声检查以评估动脉解剖结构，尤其是女性和非裔美国人。
