New research shows autogenous conduits improve patency in hemodialysis patients undergoing lower-extremity bypass surgery, but are used less often in women than in men. The study findings were published in the Journal of Vascular Surgery.

Autogenous veins are far superior, with fewer complications and better durability, yet women were less likely to receive them than men. The use of autogenous conduits was more common in men (61% vs. 55%, P<0.001) and was associated with higher patency compared with prosthetic grafts. The researchers analyzed prospectively collected data from the United States Renal Data System.

Of 9,739 infrainguinal bypass surgeries performed in hemodialysis patients between 2006 and 2011, men accounted for 61%, the team found. The most common reason for surgery was critical limb ischemia. Women who received prosthetic conduits had higher risk-adjusted odds of acute graft failure compared with men.

However, there was no significant difference between men and women who received native veins. The current standard of care calls for the use of native veins when they’re available and adequate, but this is the first large study to take a close look at specific subgroups. The findings underscore the importance of using autogenous conduits in the end-stage-renal-disease population, particularly women.

The sizable number of patients provides a good overview of outcomes in those groups, but retrospective data from an administrative database fails to describe factors such as vein quality and severity of disease. These could influence the final outcomes and conclusions. There is no way to know the caliber and quality and autologous conduits with this administrative database.

Dr Sean Lyden, chairman of vascular surgery said that matching data from the United States Renal Data system with the Medicare claims database didn’t allow the researchers to distinguish between right and left extremities. This would lead to overestimation of patency loss and the risk of ipsilateral limb salvage to the side of the bypass.

The outcomes support the use of autogenous conduits in all bypass patients on hemodialysis, especially women. The results are not clinically dramatic, but the take-home message is important. The notion that women have inadequately small veins is not always valid, adding that at least vein mapping should be performed and confirmed intraoperatively.

"The study will raise awareness about gender disparity in lower-extremity revascularization in dialysis patients, and prompt healthcare providers to address the issue. The options for venous conduits should be exhausted before offering prosthetic bypass."