Haddad David J, Jasty Venkata Sai, Mohan Babu, Hsu Chiu-Hsieh, Chong Chyi Chyi, Zhou Wei, Tan Tze-Woei
University of Arizona College of Medicine, Tucson, AZ, USA.
J Vasc Access. 2022 Jan;23(1):32-41. doi: 10.1177/1129729820970789. Epub 2020 Nov 16.
It is unclear what the optimal upper extremity hemodialysis access is for patients without a suitable cephalic vein for arteriovenous fistulas (AVFs). The objective of this systematic review and meta-analysis was to compare the outcomes for upper extremity transposed brachiobasilic AVFs (BBAVFs) and prosthetic arteriovenous grafts (AVGs).
A systematic review was performed to identify all English publications and abstracts comparing the patency outcomes of upper extremity BBAVFs and AVGs (January 1st, 1994 to April 1st, 2020). The outcomes assessed were 1-year and 2-year primary and secondary patency rates. Pooled odds ratios (OR) were calculated using the random-effects model, and statistic was used to assess between-study variability.
Twenty-three studies examining 2799 patients were identified and included in the study. The 1-year primary patency rates (OR = 1.68, 95% CI 1.24-2.28, = 0.001, = 69.40%) and 2-year primary patency rates (OR = 2.33, 95% CI 1.59-3.43, < 0.001, = 68.26%) were significantly better for BBAVFs than AVGs. Compared to AVGs, the 1-year secondary patency rates (OR = 1.45, 95% CI 1.05-1.98, = 0.022, = 56.64%) and 2-year secondary patency rates (OR = 1.93, 95% CI 1.39-2.68, < 0.001, = 57.61%) were also significantly higher for BBAVFs.
The outcomes for upper extremity BBAVFs appear to be consistently superior to prosthetic hemodialysis access. This analysis supports the preferential placement of BBAVFs over AVGs in patients with a suitable upper extremity basilic vein.
对于没有适合动静脉内瘘（AVF）的头静脉的患者，最佳的上肢血液透析通路尚不明确。本系统评价和荟萃分析的目的是比较上肢转位肱动脉-贵要静脉内瘘（BBAVF）和人工动静脉移植物（AVG）的治疗效果。
进行系统评价，以识别所有比较上肢BBAVF和AVG通畅率的英文出版物和摘要（1994年1月1日至2020年4月1日）。评估的结果是1年和2年的初级和次级通畅率。使用随机效应模型计算合并比值比（OR），并使用统计量评估研究间的变异性。
确定了23项研究，共纳入2799例患者。BBAVF的1年初级通畅率（OR = 1.68，95%CI 1.24 - 2.28，P = 0.001，I² = 69.40%）和2年初级通畅率（OR = 2.33，95%CI 1.59 - 3.43，P < 0.001，I² = 68.26%）显著优于AVG。与AVG相比，BBAVF的1年次级通畅率（OR = 1.45，95%CI 1.05 - 1.98，P = 0.022，I² = 56.64%）和2年次级通畅率（OR = 1.93，95%CI 1.39 - 2.68，P < 0.001，I² = 57.61%）也显著更高。
上肢BBAVF的治疗效果似乎始终优于人工血液透析通路。该分析支持在有合适上肢贵要静脉的患者中优先放置BBAVF而非AVG。
