Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Department of Vascular Surgery, Singapore General Hospital, Singapore.
J Vasc Surg. 2020 Jan;71(1):309-317.e5. doi: 10.1016/j.jvs.2019.07.057. Epub 2019 Sep 26.
The percutaneous endovascular approach to arteriovenous fistula (AVF) creation is a minimally invasive alternative to surgical AVF creation. This systematic review and meta-analysis aimed to investigate the efficacy and safety of endovascular AVF creation in patients with end-stage renal disease.
This study conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. An electronic search was performed on major databases to identify relevant articles. Meta-analysis of proportions and meta-regression were conducted.
Seven studies totaling 300 patients were included, of which four evaluated the everlinQ (TVA Medical, Austin, Tex) and three employed the Ellipsys (Avenu Medical, San Juan Capistrano, Calif) systems. The overall technical success rate was 97.50% (95% confidence interval [CI], 94.98-99.31%; I = 0.00%; P = .487). The 90-day maturation rate was 89.27% (95% CI, 84.00-93.66%; I = 21.29%; P = .283), and the 6-month patency and 12-month patency were 91.99% (95% CI, 87.98-95.35%; I = 0.00%; P = .780) and 85.71% (95% CI, 79.90-90.71%; I = 0.00%; P = NS), respectively. The overall procedure-related complication rate was 5.46% (95% CI, 0.310-14.42%; I = 81.21%; P = .000). Meta-regression was conducted on the pooled rates of technical success and complication, showing that age, diabetes, white race, hypertension, on dialysis, and body mass index were not significant sources of heterogeneity.
Current endovascular AVF systems appear to be effective and safe. However, given the lack of head-to-head comparative analyses with surgical AVF creation, superiority cannot be established.
经皮腔内血管通路（AVF）的创建是一种微创的替代方法，用于治疗动静脉瘘。本系统评价和荟萃分析旨在探讨腔内 AVF 治疗终末期肾病患者的疗效和安全性。
本研究符合系统评价和荟萃分析的首选报告项目指南。对主要数据库进行电子检索以确定相关文章。进行了比例的荟萃分析和荟萃回归分析。
纳入了 7 项共 300 例患者的研究，其中 4 项评估了 everlinQ（TVA Medical，Austin，Tex），3 项采用了 Ellipsys（Avenu Medical，San Juan Capistrano，Calif）系统。总的技术成功率为 97.50%（95%置信区间[CI]，94.98-99.31%；I = 0.00%；P =.487）。90 天成熟率为 89.27%（95%CI，84.00-93.66%；I = 21.29%；P =.283），6 个月通畅率和 12 个月通畅率分别为 91.99%（95%CI，87.98-95.35%；I = 0.00%；P =.780）和 85.71%（95%CI，79.90-90.71%；I = 0.00%；P = NS）。总的手术相关并发症发生率为 5.46%（95%CI，0.310-14.42%；I = 81.21%；P =.000）。对技术成功率和并发症的合并率进行了荟萃回归分析，结果表明年龄、糖尿病、白种人、高血压、透析和体重指数不是异质性的重要来源。
目前的腔内 AVF 系统似乎是有效和安全的。然而，由于缺乏与手术 AVF 治疗的头对头比较分析，因此不能确定其优越性。
