Gender Disparities in Secondary Patency of Arteriovenous Fistulas: Insights into Hemodialysis Outcomes and Long-Term Vascular Access Viability

<b>Background</b>: Autologous arteriovenous fistulas (AVFs) are the preferred vascular access modality for hemodialysis due to superior durability and lower infection rates. However, long-term secondary functional patency remains a critical determinant of dialysis success and patient survival. Although sex-related differences in vascular access outcomes have been reported, their impact on long-term secondary patency remains insufficiently clarified. <b>Objective</b>: The primary objective of this study was to evaluate long-term gender differences in the secondary functional patency of AVFs and to determine clinical, anatomical, and procedural factors contributing to these disparities. <b>Methods</b>: A retrospective cohort study including 968 ESRD patients undergoing AVF creation between 2012 and 2024 was conducted. Secondary patency was analyzed using Kaplan-Meier survival curves. Multivariate logistic regression identified independent predictors. The overall primary functional patency rates were 78.9% at 1 year, 71.2% at 3 years, and 62.7% at 5 years. When stratified by gender, male patients demonstrated primary patency rates of 80.3% at 1 year, 72.8% at 3 years, and 64.5% at 5 years, whereas female patients showed slightly lower rates of 77.3% at 1 year, 69.4% at 3 years, and 60.6% at 5 years. <b>Conclusions</b>: Female gender, particularly in the postmenopausal period, is an independent determinant of reduced long-term secondary AVF patency. Early identification of high-risk patients and structured risk factor optimization are essential to improve vascular access durability.