Vascular | 2021
Impact of arteriovenous fistulas versus arteriovenous grafts on vascular access performance in haemodialysis patients: A systematic review and meta-analysis.
Abstract
BACKGROUND\nControversy exists regarding the best-performing vascular access type for patients undergoing haemodialysis. We aimed to compare outcomes of starting dialysis on arteriovenous fistulas (AVFs) versus arteriovenous grafts (AVGs) in haemodialysis patients.\n\n\nMETHODS\nWe conducted a systematic search of multiple electronic information sources and bibliographic reference lists. The following outcome parameters were evaluated at 1, 2 and 5\xa0years: primary failure, defined as access never used for dialysis; primary patency, defined as intervention-free access survival; primary-assisted patency, defined as uninterrupted access survival with interventions; and secondary patency, defined as cumulative access survival.\n\n\nRESULTS\nWe identified 15 comparative studies reporting a total of 118,434 patients who initiated haemodialysis with AVF (n = 95,143) or AVG (n = 23,291). Our analysis demonstrated that AVF was associated with significantly higher primary failure rate (OR: 2.05, p = .0005) but significantly higher rate of primary patency at 1\xa0year (OR: 1.91, p < .00001), at 2\xa0years (OR: 2.52, p < .00001) and at 5\xa0years (OR: 2.59, p < .00001); and primary-assisted patency at 1\xa0year (OR: 1.71, p < .00001), at 2\xa0years (OR: 2.13, p < .00001) and 5\xa0years (OR: 2.79, p < .00001). There was no significant difference in secondary patency at 1\xa0year (OR: 1.08, p < .00001) but AVF had better secondary patency at 2\xa0years (OR: 1.26, p < .00001) and 5\xa0years (OR: 1.60, p < .00001) than AVG.\n\n\nCONCLUSIONS\nThe meta-analysis of best available comparative evidence (Level 2) demonstrated that AVFs may be associated with significantly higher primary failure rate but higher primary patency, primary-assisted patency and secondary patency at 1, 2 and 5\xa0years compared to AVGs. However, the available evidence is subject to significant selection bias and confounding by indication.