Yale School of Medicine, New Haven, CT; Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT.
Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT; Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT.
Ann Vasc Surg. 2023 Jul;93:128-136. doi: 10.1016/j.avsg.2023.01.052. Epub 2023 Feb 20.
Arteriovenous fistulae mature less frequently in women than in men, leading to inferior patency and decreased fistula utilization in women. We hypothesized that both anatomic and physiologic sex differences explain reduced maturation.
The electronic medical records of patients who had a primary arteriovenous fistula created from 2016 to 2021 at a single center were reviewed; sample size was determined using a power calculation. Postoperative ultrasound and laboratory tests were obtained at least 4 weeks after fistula creation. Primary unassisted fistula maturation was determined up to 4 years postprocedure.
A total of 28 women and 28 men with a brachial-cephalic fistula were analyzed. The inflow brachial artery diameter was smaller in women than in men, both preoperatively (4.2 ± 0.9 vs. 4.9 ± 1.0 mm, P = 0.008) and postoperatively (4.8 ± 0.8 vs. 5.3 ± 0.9 mm, P = 0.039). Despite similar preoperative brachial artery peak systolic velocity, women had significantly lower postoperative arterial velocity (P = 0.027). Fistula flow was reduced in women, particularly in the midhumerus (747.0 ± 570.4 vs. 1,117.1 ± 471.3 cc/min, P = 0.003). Percentages of neutrophils and lymphocytes were similar among women and men 6 weeks after fistula creation. However, women had reduced monocytes (8.5 ± 2.0 vs. 10.0 ± 2.6%, P = 0.0168). Among 28 men, 24 of 28 (85.7%) achieved unassisted maturation, whereas only 15 of 28 (53.6%) women had fistulae that matured without intervention. Secondary analysis using logistic regression suggested that postoperative arterial diameter was associated with maturation in men, while postoperative monocyte percentage was associated with maturation in women.
Sex differences during arteriovenous fistula maturation are present in arterial diameter and velocity, suggesting that both anatomic and physiologic differences in arterial inflow contribute to sex differences in fistula maturation. In men, postoperative arterial diameter is correlated with maturation, whereas in women, the significantly lower proportion of circulating monocytes suggests a role for the immune response in fistula maturation.
动静脉瘘在女性中的成熟频率低于男性，导致女性的通畅率和瘘管使用率降低。我们假设解剖和生理性别差异解释了成熟度的降低。
回顾了 2016 年至 2021 年在单一中心接受初次动静脉瘘的患者的电子病历；使用功效计算确定样本量。术后至少 4 周获得超声和实验室检查。术后 4 年确定原发性非辅助瘘成熟度。
共分析了 28 名女性和 28 名男性肱动脉-头静脉瘘患者。女性的流入肱动脉直径术前（4.2±0.9 vs. 4.9±1.0mm，P=0.008）和术后（4.8±0.8 vs. 5.3±0.9mm，P=0.039）均小于男性。尽管术前肱动脉峰值收缩速度相似，但女性术后动脉速度明显较低（P=0.027）。女性瘘管流量减少，尤其是在肱骨干中部（747.0±570.4 vs. 1117.1±471.3cc/min，P=0.003）。瘘管形成后 6 周，女性和男性的中性粒细胞和淋巴细胞百分比相似。然而，女性的单核细胞减少（8.5±2.0 vs. 10.0±2.6%，P=0.0168）。在 28 名男性中，28 名中有 24 名（85.7%）未接受干预即实现成熟，而 28 名女性中仅有 15 名（53.6%）瘘管成熟。使用逻辑回归的二次分析表明，男性的术后动脉直径与成熟相关，而女性的术后单核细胞百分比与成熟相关。
动静脉瘘成熟过程中的性别差异存在于动脉直径和速度中，表明动脉流入的解剖和生理差异都导致了瘘管成熟的性别差异。在男性中，术后动脉直径与成熟相关，而在女性中，循环单核细胞的比例明显较低，提示免疫反应在瘘管成熟中起作用。
