Purpose: to evaluate in chronically-haemodialysed patients (CHP) if, 1) the vascular access (VA) position (arm or forearm) is associated with differential changes in upper-limb arterial stiffness; 2) differences in arterial stiffness exist between genders associated with the VA; 3) the vascular substitute (VS) of choice, in biomechanical terms, depends on the previous VA location and CHP gender.

Methods: Clinical and biochemical parameters and left and right carotid-brachial pulse wave velocity (PWVcb) were measured in 38 CHP (males:18; Age:53±17 years; VA in arm:18). In in vitro studies, PWV was obtained from ePTFE prostheses and human arterial and venous homografts (brachial, femoral and carotid arteries and saphenous veins). The biomechanical mismatch (BM) between CHP native vessel (NV) and VS was calculated.

Results: PWVcb in upper-limbs with VA was lower than in the intact contralateral limbs, and differences were higher (P<0.02) when the VA was performed in the arm. Differences between PWVcb in upper limbs with VA (in the arm) with respect to intact upper-limbs were higher (P<0.01) in males than in females. Independently of the arterial region in which the VA was performed, the type of homograft that ensured the minimal BM was the brachial artery. The BM between VS and NV was highly dependent on gender and the location in the upper-limb in which the VA was performed.

Conclusions: In CHP, both gender and the arterial territory in which the VA is performed determined differences in arterial stiffness. BM between VS and NV determines different prostheses alternatives in the VA construction.