Comparison between transposed arteriovenous fistulas and arteriovenous graft for the hemodialysis patients: A meta-analysis and systematic review.

Q3 Medicine
Qian-Hui Tang, Han Yang, Jing Chen, Qiu-Ning Lin, Zhong Qin, Ming Hu, Xiao Qin
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引用次数: 0

Abstract

It is challenging for a surgeon to determine the appropriate vascular access for hemodialysis patients whose cephalic vein is usually inaccessible. The purpose of the study is to compare the complications and patency rates between transposed arteriovenous fistulas (tAVF) and arteriovenous graft (AVG) for the hemodialysis patients. Studies were recruited from PubMed, Cochrane library, EMBASE, the web of science databases, and reviewing reference lists of related studies from the inception dates to September 2, 2021. Statistical analyses were conducted using the statistical tool Review Manager version5.3 (Cochrane Collaboration, London, UK). I2 > 50% was defined as a high degree of heterogeneity, and then a random-effects model was used. Otherwise, the fixed-effects model was used. Odds ratio with its 95% confidence interval (95% CI) was used. Thirty-three trials (26 retrospective studies, four randomized controlled trials, two prospective trials, and one controlled-comparative study) with 6430 enrolled participants were identified in our analysis. The results showed that tAVF was accompanied with lower thrombosis rate (103/1184 (8.69%) vs 257/1367 (18.80%); I2 = 45%; 95% CI, 0.34 (0.26, 0.45)) and infection rate (43/2031 (2.12%) vs 180/2147 (8.38%); I2 = 0%; 95% CI, 0.20 (0.14, 0.30)) than arteriovenous graft. The significantly better primary patency rates, secondary patency rates, and primary assisted patency rates during follow-up were found in tAVF. However, the failure rate and the prevalence of hematoma were significantly lower in AVG group. No evidence showed the rate of overall mortality, steal syndrome, and aneurysm reduced in tAVF. Our results showed that tAVF is a promising vascular access technique for hemodialysis patients whose cephalic vein is inaccessible. Our data showed that tAVF has less thrombosis, infection risk, and better patency rates when compared with AVG. However, more attentions need to be paid to transposed arteriovenous fistulas maturation and hematoma.

血液透析患者转位动静脉瘘与动静脉移植的比较:荟萃分析和系统综述。
血液透析患者的头静脉通常无法进入,对于外科医生来说,确定合适的血管通路是一项挑战。本研究旨在比较血液透析患者转位动静脉瘘(tAVF)和动静脉移植(AVG)的并发症和通畅率。研究从 PubMed、Cochrane 图书馆、EMBASE、web of science 数据库中收集,并查阅了自开始日期至 2021 年 9 月 2 日的相关研究参考文献列表。统计分析使用统计工具 Review Manager 5.3 版(Cochrane Collaboration,英国伦敦)进行。I2>50%定义为高度异质性,然后使用随机效应模型。否则采用固定效应模型。使用了带有 95% 置信区间 (95% CI) 的比值比。我们在分析中确定了 33 项试验(26 项回顾性研究、4 项随机对照试验、2 项前瞻性试验和 1 项对照比较研究),共 6430 名参与者。结果显示,与动静脉移植相比,tAVF 的血栓形成率(103/1184 (8.69%) vs 257/1367 (18.80%);I2 = 45%;95% CI, 0.34 (0.26, 0.45))和感染率(43/2031 (2.12%) vs 180/2147 (8.38%);I2 = 0%;95% CI, 0.20 (0.14, 0.30))更低。在随访中发现,tAVF的一次通畅率、二次通畅率和一次辅助通畅率均明显优于动静脉移植术。但 AVG 组的失败率和血肿发生率明显较低。没有证据显示 tAVF 的总死亡率、盗血综合征和动脉瘤发生率降低。我们的研究结果表明,对于头静脉无法进入的血液透析患者来说,tAVF 是一种很有前途的血管通路技术。我们的数据显示,与 AVG 相比,tAVF 的血栓形成和感染风险更低,通畅率更好。然而,转位动静脉瘘的成熟和血肿问题还需引起更多关注。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
JAVA - Journal of the Association for Vascular Access
JAVA - Journal of the Association for Vascular Access Medicine-Medicine (miscellaneous)
CiteScore
1.10
自引率
0.00%
发文量
22
期刊介绍: The Association for Vascular Access (AVA) is an association of healthcare professionals founded in 1985 to promote the emerging vascular access specialty. Today, its multidisciplinary membership advances research, professional and public education to shape practice and enhance patient outcomes, and partners with the device manufacturing community to bring about evidence-based innovations in vascular access.
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