AVF Core Values: Diversity and Equity in Venous Disease Care

Insurance and Access Barriers

Medicare contractors apply inconsistent coverage determinations for venous procedures, pelvic venous disease remains classified as experimental despite common presentation in clinic, and Black patients use arteriovenous fistulas for hemodialysis less often than any other racial group.

Bias in Clinical Trial Design

African American and Hispanic patients are underrepresented in clinical trial enrollment relative to their share of the population, a gap linked to distrust in the medical community, transportation barriers, and low diversity among research teams, with only half of randomized trials reporting race.

Racial Disparities in Superficial Venous Disease

A database review of 66,000 patients found Hispanic and Asian patients had the best superficial venous outcomes with fewer ablations needed, while Black patients presented more often with C0 disease linked to obesity and arthritis, with lower treatment rates despite higher severe disease rates.

Disparities in Deep Venous Disease

Risk calculators for venous thromboembolism omit race and inconsistently address sex, yet population data show Black patients have the highest rates of deep vein thrombosis and pulmonary embolism, with panelists debating genetics, socioeconomics, or access as explanations.