Journal of Vascular Surgery
Volume 48, Issue 5, Supplement , Pages S34-S47, November 2008

Autogenous versus prosthetic vascular access for hemodialysis: A systematic review and meta-analysis

  • M. Hassan Murad, MD, MPH

      Affiliations

    • Knowledge and Encounter Research Unit, Mayo Clinic, Rochester, Minn
    • Division of Preventive Medicine, Mayo Clinic, Rochester, Minn
    • Corresponding Author InformationCorrespondence: M. Hassan Murad, MD, MPH, Mayo Clinic, Division of Preventive, Occupational and Aerospace Medicine, 200 1st St SW, Rochester, MN 55905
    • ,
  • Mohamed B. Elamin, MBBS

      Affiliations

    • Knowledge and Encounter Research Unit, Mayo Clinic, Rochester, Minn
    • ,
  • Anton N. Sidawy, MD, MPH

      Affiliations

    • Department of Surgery, VA Medical Center, Georgetown and George Washington Universities, Washington, DC
    • ,
  • German Malaga, MD, MSc

      Affiliations

    • Knowledge and Encounter Research Unit, Mayo Clinic, Rochester, Minn
    • ,
  • Adnan Z. Rizvi, MD

      Affiliations

    • Division of Vascular Surgery, Mayo Clinic, Rochester, Minn
    • ,
  • David N. Flynn, BS

      Affiliations

    • Knowledge and Encounter Research Unit, Mayo Clinic, Rochester, Minn
    • ,
  • Edward T. Casey, MD

      Affiliations

    • Division of Nephrology, Mayo Clinic, Rochester, Minn
    • ,
  • Finnian R. McCausland, MD

      Affiliations

    • Knowledge and Encounter Research Unit, Mayo Clinic, Rochester, Minn
    • ,
  • Martina M. McGrath, MD
    • ,
  • Danny H. Vo, MD

      Affiliations

    • Knowledge and Encounter Research Unit, Mayo Clinic, Rochester, Minn
    • ,
  • Ziad El-Zoghby, MD

      Affiliations

    • Division of Nephrology, Mayo Clinic, Rochester, Minn
    • ,
  • Audra A. Duncan, MD

      Affiliations

    • Division of Vascular Surgery, Mayo Clinic, Rochester, Minn
    • ,
  • Michal J. Tracz, MD

      Affiliations

    • Division of Nephrology, Mayo Clinic, Rochester, Minn
    • ,
  • Patricia J. Erwin, MLS

      Affiliations

    • Knowledge and Encounter Research Unit, Mayo Clinic, Rochester, Minn
    • ,
  • Victor M. Montori, MD, MSc

      Affiliations

    • Knowledge and Encounter Research Unit, Mayo Clinic, Rochester, Minn
    • Division of Endocrinology, Mayo Clinic, Rochester, Minn

Received 7 August 2008; accepted 9 August 2008.

Article Outline

Objectives

The autogenous arteriovenous access for chronic hemodialysis is recommended over the prosthetic access because of its longer lifespan. However, more than half of the United States dialysis patients receive a prosthetic access. We conducted a systematic review to summarize the best available evidence comparing the two accesses types in terms of patient-important outcomes.

Methods

We searched electronic databases (MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science and SCOPUS) and included randomized controlled trials and controlled cohort studies. We pooled data for each outcome using a random effects model to estimate the relative risk (RR) and its associated 95% confidence interval (CI). We estimated inconsistency caused by true differences between studies using the I2 statistic.

Results

Eighty-three studies, of which 80 were nonrandomized, met eligibility criteria. Compared with the prosthetic access, the autogenous access was associated with a significant reduction in the risk of death (RR, 0.76; 95% CI, 0.67-0.86; I2 = 48%, 27 studies) and access infection (RR, 0.18; 95% CI, 0.11-0.31; I2 = 93%, 43 studies), and a nonsignificant reduction in the risk of postoperative complications (hematoma, bleeding, pseudoaneurysm and steal syndrome, RR 0.73; 95% CI, 0.48-1.16; I2 = 65%, 31 studies) and length of hospitalization (pooled weighted mean difference –3.8 days; 95% CI, –7.8 to 0.2; P = .06). The autogenous access also had better primary and secondary patency at 12 and 36 months.

Conclusion

Low-quality evidence from inconsistent studies with limited protection against bias shows that autogenous access for chronic hemodialysis is superior to prosthetic access.

 

Several studies have demonstrated that autogenous arteriovenous access for chronic hemodialysis has longer patency compared with prosthetic access.1, 2 The National Kidney Foundation Dialysis Outcomes Quality Initiative (NKF KDOQI) advocates the use of autogenous access if possible in all clinical scenarios.3

Nevertheless, the prosthetic access is widely used in the United States, to the extent that in 2002, it represented 80% of accesses used in prevalent dialysis patients compared with 24% in Europe.4 The increased use of prosthetic access may be attributed to putative benefits in some patients such as women and the elderly,5, 6, 7 the availability of off-the-shelf conduit for placement, the higher reimbursement associated with prosthetic access placement, the ability to cannulate and use the prosthetic access without waiting for maturation, more amenability of the prosthetic access to thrombectomy, and the high nonmaturity rate of the autogenous access.8, 9, 10 To our knowledge, no published systematic reviews have evaluated the two types of accesses in terms of patient-important outcomes other than patency, such as death and sepsis.

To aid physicians and patients in making informed choices about the placement and management of hemodialysis access, the Society for Vascular Surgery created a multispecialty committee to produce clinical practice guidelines based on the best available evidence. The aim of this review is to inform the development of these guidelines and compare the two types of accesses in terms of patient-important outcomes.

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Methods 

The report of this protocol-driven systematic review was approved by the Society for Vascular Surgery and adheres to the standards for reporting Meta-analysis Of Observational Studies in Epidemiology (MOOSE).11 Whenever possible, we used the nomenclatures and definitions as published in the “Recommended Standards for Reports Dealing with Arteriovenous Hemodialysis Accesses” by the Society for Vascular Surgery.12

Eligibility criteria 

We sought to include randomized controlled trials (RCTs) and cohort studies that compared a group of patients that have an autogenous access with a concurrent comparison group that had a prosthetic access. The outcomes of interest were death, access infection, postoperative complications, the duration of hospitalization due to access complications, and patency. We included studies regardless of their language, size, or duration of patient follow-up.

Study identification 

An expert reference librarian designed and conducted the electronic search strategy with input from study investigators with expertise in conducting systematic reviews. To identify eligible studies, we searched electronic databases (MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science and SCOPUS) through March 2007. The search strategy, which was tailored to each database, included controlled vocabulary and text words describing vascular access in hemodialysis (including terms for renal disease, methods of vascular access, and access type). We also sought references from experts, bibliographies of included studies, and the ISI Science Citation Index for publications that cited included studies (details are available from the authors upon request).

References were uploaded in a Web-based software package developed for systematic review data management (SRS, TrialStat Corporation, Ottawa, Ontario Canada). Paired reviewers working independently screened all abstracts and titles for eligibility. References that were deemed potentially relevant were retrieved in full text and uploaded for full text evaluation against eligibility criteria. Disagreements were resolved by consensus (the two reviewers discussed the study and reached a consensus) and by arbitration (a third reviewer adjudicated the study) when disagreement continued.

Data collection 

Teams of reviewers working independently and in duplicates and using standardized forms extracted descriptive, methodologic, and outcome data from all eligible studies. Outcomes were extracted from text, tables, and graphs (survival curves). Study quality was assessed using the Newcastle-Ottawa Scale for assessing the quality of observational studies.13 We sent e-mails to authors of all included studies to obtain missing data and to verify the presence of any collected but unreported data. When e-mail addresses were not published (particularly for older studies), we searched for authors' newer publications or attempted to contact their institutions to obtain current e-mail addresses.

Statistical analysis 

Meta analyses 

We pooled relative risks (RR) from each trial using the DerSimonian-Laird random effects model and estimated the 95% confidence intervals (CIs) for each outcome.14 Patency rates were converted to dichotomous outcomes for specific time periods (12 and 36 months).6 In all analyses in this review, a RR <1.0 indicates benefit from autogenous access vs prosthetic access. We assessed the heterogeneity among studies using the I2 statistic, which represents the proportion of variability across studies that is not due to chance or random error but rather is due to real differences in study design, population, or interventions.15 I2 values of 25%, 50%, and 75% indicate low, moderate, and high heterogeneity, respectively. Statistical analysis was conducted by using Comprehensive Meta-Analysis 2 software (Biostat Inc, Englewood, NJ; 2005).

Subgroup analyses 

A priori hypotheses to explain potential heterogeneity in the direction and magnitude of effect among included studies were patients' age (children vs adult, age ≥65 vs <65 years), gender, diabetes status, the presence of peripheral vascular disease, the location of the access (upper arm vs lower arm), and whether studies reported outcomes per patient or per access and whether patients were incidental or prevalent hemodialysis patients. Also, we conducted meta-regression to determine whether study quality or the length of study follow-up (predictor variables) affected patency outcomes (dependent variable).

Sensitivity analyses 

We conducted sensitivity analyses to test the effect of including studies in which investigators determined study outcomes clinically or from administrative databases (eg, billing codes). Using billing/administrative data to determine outcomes reduces the bias caused by outcome assessors not being blinded but introduces misclassification bias (intentional or unintentional erroneous coding). We conducted sensitivity analysis with and without the assumption that denatured homologous vein grafts and saphenous vein grafts are considered autogenous accesses. We also explored the robustness of our results by analyzing the data with accounting for censoring in time-to-event outcomes according to the method of Pramar et al.16

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Results 

Study identification 

Our search and selection procedures yielded 995 potentially eligible references, of which 99 proved eligible and 83 provided data for meta-analyses (Fig 1). Study characteristics are summarized in Table I.5, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98 The chance adjusted inter-reviewer agreement (κ statistic) for study eligibility averaged 0.78 (range, 0.61-1.00). These studies enrolled 69,816 participants (mean size, 850 patients; mean age, 55 years; mean follow-up, 2.8 years). Authors from 26 of the 83 included studies (31%) responded to our e-mail queries and provided missing data. Seven studies were translated to English.1, 24, 99, 40, 100, 101, 102

Table I. Baseline characteristics for included studies
First author, yearPatients, No.Mean Age, yIncidental/prevalentAutogenousProstheticF/U, dStudy design
LocationVesselsLocationVessels
Haimov,17 1980126aNRIncUpper armBrachiocephalicForearm, upper arm, thighRadiocephalic, brachiocephalic, femoralNRProsp
Mangiarotti,18 1983205NRNRForearm, upper arm, thigh36.96 brachial, 7.04 radial; 22.88 cephalic vein, 7.04 basilic, 14.08 other veinsForearm, upper arm, thigh22 brachial, 1 arterial stump from prosthesis; 8 brachial, 8 basilic, 3 cephalic, 4 other veins1740Retro
ATordoir,19 198314949IncForearmRadiocephalicForearm, upper arm, thighRadiocephalic, brachiocephalic, saphenofemoral1145Prosp
Louridas,20 198415243NRForearm, upper armRadiocephalic, brachiocephalicForearm, upper arm, thighBrachial to axillary, axillary to femoral, axillary to basilic, axillary to cephalicNRRetro
Winsett,21 198550845PrevForearmRadiocephalic, brachiocephalicForearmRadiocephalic, brachiocephalic, brachiocubital730Retro
Kherlakian,22 198620052IncForearmRadiocephalicUpper arm, thighBrachiocephalic, brachiobasilic, femoral1095Retro
Zibari,23 198823052MixedForearm, upper armBrachiocephalic, radiocephalicForearm, upper arm, thighRadiocephalic, brachioaxillary, femoral, femoral-poplitealNRRetro
Filiptsev,24 198984NRNRMultiple (shoulder, upper arm, thigh)NRMultiple (shoulder, upper arm, thigh)NRNRProsp
Nazzal,25 199012537IncForearm, upper armRadiocephalic, brachiocephalicUpper armBrachioaxillary300Prosp
Sands,26 199211164NRNRNRNRNR180Retro
Churchill,27 1992347≥18IncNRNRNRNRNRProsp
Tang,28 19926350PrevNRNRNRNR300Prosp
Sanabia,29 1993749IncUpper arm, forearmRadiocephalic, ulnar basilic, antecubitalForearm, upper arm, thigh, neckRadiocephalic, brachiocephalic, brachiojugular, femoralNRRetro
Taylor,30 19931897NRIncNRNRNRNRNRRetro
Al-Wakeel,31 199410542IncForearm, upper armRadiocephalic, brachiocephalicForearm, upper armRadiocephalic, brachiocephalic1825Retro
Bender,32 19946862MixedElbow, wristRadiocephalic, brachiocephalicForearm, upper armNR1095Retro
Chalabi,33 19948451IncNRSaphenous veinUpper armHumeroaxillary, humerobasilic, humerocephalic1825Retro
Coburn,34 19948165IncUpper armBrachiobasilicUpper armBrachiobasilic, Brachioaxillary, BrachiocephalicNRRetro
Riordan,35 199446448IncForearmRadiocephalicForearm, upper arm, thighRadiocephalic, brachiocephalic, femoralNRRetro
Chazan,36 199511757PrevNRNRNRNR425Prosp
Kim,37 199517243NRNRNRNRNR510Retro
Sands,38 1995107NRIncNRNRNRNR772Retro
Tedoriya,39 199511347IncForearm, upper armRadiocephalic, ulnar basilic, snuffbox, brachiocephalicNRNR6570Retro
Vaccaro,40 199527656PrevForearmRadiocephalicUpper armPTFE730Retro
Enzler,41 199641444MixedForearm, upper armNRForearm, upper arm, thighNRNRRetro
Herzig,42 199739158IncMultipleNRMultipleNRNRRetro
Hodges,43 199735059IncForearm, upper armRadiocephalic, brachiocephalicForearm, upper arm, thighNRNRRetro
Miller,44 19977664IncForearm, upper armCephalic, brachial, radial, basilicUpper armBrachiocephalic loop or straight graft455Retro
Sparks,45 199742754IncForearm, upper armRadiocephalic, brachiocephalic, brachiocubitalUpper armLoop brachial-cephalic/basilic or a bridge radial-cephalic/basilic construction.1026Retro
Woods,46 199778466MixedNRNRNRNR365Retro
Bay,47 1998279260PrevUpper arm (6.4%), forearm (20.6%)NRForearm straight (14.7%), forearm loop (24.8%), upper arm straight (26.1%), upper arm loop (3.8%), femoral graft (2.3%)NR365Prosp
Miranda,48 19981308aNRPrevForearm or upper armCephalic or basilic veinsForearm, upper arm, thigh, chestCephalic, basilic, femoral, axillary180Retro
Berardinelli,49 199834872IncForearm, upper armRadiocephalic, brachiocephalicForearm, upper armRadiocephalic, brachiocephalic5475Retro
Bosman,50 199813160IncForearm, upper arm, thighDenatured homologous vein graft, straight radiocephalic, loop radiocephalic, brachiocephalic, femoral.Forearm, thighPTFE: loop radiocephalic, straight radiocephalic, femoral326RCT
Cante,51 19985174IncForearmNRForearmNR730Retro
Jenkins,52 198056NRIncForearm, upper arm, thighRadiocephalic, brachiocephalic, femoralForearm, upper arm, thighRadiocephalic, brachiocephalic, femoralNRProsp
Matsuura,53 19989861IncUpper armBrachioaxillary, basilic vein transpositionUpper armBrachioaxillaryNRRetro
Obialo,54 19983642NRForearmRadio cephalicUpper armBrachiocephalic365Prosp
Silva,55 199817263IncForearm, upper armNRForearm, upper armRadiocephalic, brachioaxillary401Prosp
Wang,56 199813160PrevMultipleNRMultipleNR180Prosp
Agarwal,57 19993256PrevNRNRNRNR252Prosp
Turnbull,58 1999166NRIncForearm, upper armRadiocephalic, brachiocephalic, brachiobasilicForearm, upper armRadiocephalic, brachiocephalic, straight, loopNRRetro
Ascher,59 200024769IncForearm, upper armRadiocephalic, brachiocephalic, brachiobasilicNRNR270Retro
Astor,5 200083363PrevNRNRNRNR395Retro
Rodriguez,60 200054456NRForearm, upper armRadiocephalic, brachiocephalic, humerobasilarUpper arm, thighHumerocephalic, humerobasilic, femoro-femoral2532Retro
Staramos,61 200011478IncForearm, upper armRadiocephalic, brachiocephalic, basilic transpositionForearm, upper arm, thighBrachiocephalic, brachioaxillary, femoral1095Prosp
Brunori,62 200020368IncForearm, upper armRadiocephalic, brachiocephalicNRNRNRRetro
Dhingra,63 2001446959PrevNRNRNRNR730Prosp
Gibson,64 200115256MixedNRNRNRNR511Retro
Gibson,65 2001158366IncNRNRNRNR340Retro
Oliver,66 200119557IncUpper armBrachiocephalic, brachiobasilic transpositionUpper armBrachioaxillary600Retro
Dixon,67 200220456IncForearm, upper armRadiocephalic, brachiocephalicForearmForearm loop radiocephalic1825Prosp
Lawrence,68 20027157PrevNRNRNRNRNRRetro
Pastan,69 2002740358PrevNRNRNRNR260Retro
Ridao-Cano,70 200287256IncForearm, upper armRadiocephalic, basiocephalicForearm, upper armRadiocephalic, brachiocephalic, straight, loop grafts1825Retro
Saxena,71 200221848PrevNRNRNRNR1460Prosp
Sheth,72 20023413IncForearm, upper arm, thighRadiocephalic, brachiocephalic, femoralForearm, upper arm, thighRadiocephalic, brachiocephalic, femoral3650Retro
Valentine,73 20027257IncUpper armBrachial-based arteriovenous fistulaUpper arm, forearmRadiocephalic, brachiocephalic, straight or loop180Prosp
Johnson,74 2002207>50NRWrist, elbowNRNRNR360Prosp
Baaran,75 2003295038IncForearm, upper armRadiocephalic, brachiocephalicUpper armNR1160Retro
Cernadas,76 20036061IncUpper armTransposed brachiobasilicUpper armPTFE brachioaxillary bridge fistula730Retro
Choi,77 20039754NRForearm, upper armRadiocephalic, brachiocephalic, brachiobasilic, transposed, non-transposedForearm, upper armBrachioaxillary, mediocubital, cephalic or basilic vein545Retro
Culp,78 199526762IncForearm, upper armNRForearm, upper armNR365Prosp
Fisher,79 200319761IncForearm, upper armRadiocephalic, brachiocephalicForearm, upper arm, thighForearm loop, upper arm loop, thigh loop780Retro
Shenoy,80 2003111059PrevNRNRNRNR730Retro
Xue,81 200325226>=67MixedNRNRNRNR365Retro
Yu,82 20038261PrevNRNRNRNR365Prosp
Di Iorio,83 2004220162PrevNRNRNRNR730Retro
Hazinedaroglu,84 20043059IncThighFemoral vein transpositionThighSuperficial femoral artery to saphenous or common femoral vein237Prosp
Kizilisik,85 20049361IncForearm, upper armRadiocephalic, brachiocephalic, brachiobasilicForearm, upper armStraight, loop600Retro
Perera,86 200420957IncUpper armRadiocephalic mainly, brachiocephalic. Basilic vein used in 4Upper armBrachial mainly, radial. Outflow brachial/axillary, basilic vein1095Retro
Polkinghorne,87 20042632>18IncNRNRNRNR1095Retro
Akoh,88 200515162IncForearm, upper armBrachiocephalic, radiocephalicForearm, upper arm, chest, thighForearm straight, forearm loop, brachioaxillary, femoral, axillary567Retro
Astor,89 200520659IncNRNRNRNR810Retro
Fitzgerald,90 200514656IncUpper armBrachiocephalic, brachiobasilic, brachiomedianForearmBrachiobasilic, brachiocephalic, brachiomedian430Retro
Kawecka,91 200572244MixedUpper and lower extremitiesRadiocephalic, brachiocephalic and brachiobasilicUpper and lower armNR570Retro
Manns,92 200523963NRForearm, upper armRadiocephalic, brachiocephalicUpper armBrachiocephalicNRRetro
Ramage,93 200511412IncUpper armRadiocephalic, brachiocephalicForearm, upper arm, thighRadiocephalic, brachiocephalic, femoral7300Retro
Rooijens,94 200538360IncForearmRadiocephalicForearmBrachiocephalic365RCT
Ates,95 200692042IncForearm, upper armRadiocephalic, brachiocephalicUpper armBrachioaxillary, brachiocephalic1825Retro
Roca-tey,96 20068963PrevUpper armRadiocephalic, brachiocephalicUpper arm, thighBrachiocephalic, femoral354Prosp
Woo,97 200732965PrevUpper armNRUpper armNR860Retro
Keuter,98 200810563PrevUpper armBrachial-basilicForearmBrachial antecubital forearm loop365RCTb

F/U, Follow-up, Inc, incidental dialysis patients; NR, not reported; Prev, prevalent dialysis patients; Pros, prospective; PTFE, polytetrafluoroethylene; Retro, retrospective; RCT, randomized controlled trial.

aThis is the number of accesses; number of patients is not reported.

bCommunication with author indicates that patients and care givers were not blinded, data collectors were blinded, and allocation was concealed.

Methodologic quality 

Three studies were open randomized trials,50, 94, 98 and 80 were observational studies, of which 56 had a retrospective cohort design and 24 had a prospective cohort design. Allocation was concealed and data collectors were blinded in one of the randomized trials.98 The distribution of the Newcastle-Ottawa quality scale components that describe the quality of observational studies are summarized in Table II. Only 46% of the studies controlled for at least one possible confounder in cohort selection or analysis. The proportion lost to follow-up was <10% in only 19% of the studies. Only 20% of the studies reported a funding source. Inter-reviewer agreement (κ statistic) of the different components of quality averaged 0.70 (range, 0.53-1.00).

Table II. Distribution of components of the Newcastle-Ottawa quality scale of cohort studies
ComponentStudies, No. (%)
Cohort selection
Study cohorts are representative of the typical patients encountered in practice
Yes77(96)
No or not reported3(4)
Exposure ascertainment (type of access)
Adequate (clinical exam or chart review)63(79)
Inadequate (self-report or not reported)17(21)
Studies confirmed that the access was functional at the outset
Yes20(25)
No or not reported60(75)
Cohort comparability
Studies controlled for possible confounders in cohort selection or analysis
Controlled for 2 or more confounders30(37)
Controlled for one confounder7(9)
Did not control for confounders43(54)
Outcome
Outcome assessment
Adequate (physical exam, chart review, record linkage)56(70)
Inadequate (self-report, not reported)24(30)
The length of follow-up adequate to assess outcomes
equal or >12 months47(59)
<12 months33(41)
Proportion lost to follow-up
≤10%15(19)
>10%65(81)

Meta-analyses 

The autogenous access was associated with a significant reduction in the risk of death (RR, 0.76; 95% CI, 0.67-0.86; I2 = 48%; 27 studies; Fig 2) and access infection (RR, 0.18; 95% CI, 0.11-0.31; I2 = 93%; 43 studies; Fig 3). The autogenous access was also associated with a nonsignificant reduction in the risk of postoperative complications of access placement other than infection, including hematoma, bleeding, pseudoaneurysm, and steal syndrome (RR, 0.73; 95% CI, 0.48-1.12; I2 = 65%, 31 studies; Fig 4). The length of hospitalization related to access complications was lower in patients who had autogenous accesses (pooled weighted mean difference –3.8 days; 95% CI –7.8 to 0.2; P = .06; 3 studies).

  • View full-size image.
  • Fig 2. 

    Meta-analysis of the effect of access type on the risk of death. The vertical line indicates no treatment effect; the squares and horizontal lines, point estimates and associated 95% confidence intervals (CIs) for each study; diamonds, random-effects pooled relative risk (RR) of death.

  • View full-size image.
  • Fig 3. 

    Meta-analysis of the effect of access type on the risk of access infection. The vertical line indicates no treatment effect; squares and horizontal lines, point estimates and associated 95% confidence intervals (CIs) for each study; diamonds, random-effects pooled relative risk (RR) of access infection.

  • View full-size image.
  • Fig 4. 

    Meta-analysis of the effect of access type on the risk of access complications other than infection. The vertical line indicates no treatment effect; squares and horizontal lines, point estimates and associated 95% confidence intervals (CIs) for each study; diamonds, random-effects pooled relative risk (RR) of access complications.

Primary and secondary patency rates at 12 and 36 months were significantly higher in the autogenous than in the prosthetic access. RRs for access failure without interventions to maintain or re-establish patency were 0.72 (95% CI, 0.65-0.80) at 12 months and 0.67 (95% CI, 0.58-0.78 at 36 months. RRs for access failure including interventions to maintain or re-establish patency were 0.83 (95% CI, 0.70-0.99) at 12 months and 0.67 (95% CI, 0.61-0.74) at 36 months.

Subgroup analyses 

One of the a priori established analyses to explain heterogeneity of results is autogenous access location (upper arm vs lower arm, both compared with prosthetic access at any location). We found a significant access location–access complications interaction (P = .02) demonstrating that the magnitude of benefit from autogenous access vs prosthetic access is significantly more when autogenous access was placed in the lower arm. There were no significant death–access location, access infection–access location or patency–access location interactions (P =.60, P = .18, and P = .33, respectively).

Only two studies compared the autogenous upper arm access with a prosthetic lower arm access (prosthetic looped forearm access).90, 98 Pooling the outcomes of the two studies (a total of 249 patients) demonstrates that the placement of autogenous access in the upper arm is associated with a significantly lower rate of infections (RR, 0.23; 95% CI, 0.07-0.83) and nonsignificant trends for better 12-month primary (RR, 0.88; 95% CI, 0.72-1.07) and secondary (RR, 0.81; 95% CI, 0.54-1.20) patency. Patency at 24 months was only reported by Fitzgerald et al90 and was similar between the two accesses. Both studies reported the upper arm placement of autogenous access to be associated with fewer complications and to require fewer interventions to maintain patency.

Interactions based on patient type (incidental vs prevalent hemodialysis) for outcomes of death, access infections, access complications, and patency were all nonsignificant (P = .4, P = .77, P = .43, and P = .33, respectively).

Several studies reported outcomes by access rather than by patient, a unit-of-analysis challenge given the likely correlation of outcomes for accesses in the same patient. However, the results in studies reporting patency, access complications, and access infection, per patient vs per access, were not different (P = .80, P = .43 and P = .33, respectively).

There were no significant patency-gender or patency-age (>65 or <65 years) interactions. A significant patency-age interaction (pediatric vs adults) was found in a single, small pediatric study that showed the autogenous access patency in children was inferior to that of the prosthetic access at 12 and 36 months (P = .02 and P = .07, respectively); however, autogenous patency regained superiority at 60 months of follow-up.72 Subgroup analyses are summarized in Table III.

Table III. Subgroup analyses
VariableStudies, No.RR (95% CI)P (interaction test)
Death
Upper arm autogenous vs prosthetic60.68(0.25-1.83)0.55
Lower arm autogenous vs prosthetic30.46(0.21-1.01)
Incidental HD patients190.72(0.58-0.89)0.74
Prevalent HD patients50.76(0.60-0.97)
Access infection
Upper arm autogenous vs prosthetic110.21(0.12-0.36)0.17
Lower arm autogenous vs prosthetic50.10(0.04-0.24)
Studies that used access data290.21(0.12-0.35)0.33
Studies that used patient data130.34(0.15-0.74)
Incidental HD patients300.22(0.11-0.47)0.77
Prevalent HD patients50.26(0.09-0.70)
Access complications
Upper arm autogenous vs prosthetic91.22(0.48-3.10)0.02
Lower arm autogenous vs prosthetic50.20(0.06-0.68)
Studies that used access data210.69(0.42-1.11)0.43
Studies that used patient data101.06(0.41-2.71)
Incidental HD patients220.86(0.48-1.53)0.43
Prevalent HD patients40.56(0.23-1.35)
Primary patency at 12 months
Upper arm autogenous vs prosthetic140.70(0.56-0.88)0.09
Lower arm autogenous vs prosthetic110.94(0.73-1.20)
Males20.50(0.39-0.65)0.64
Females20.65(0.22-1.88)
Old (>65)20.57(0.25-1.32)0.56
Young (≤65)20.89(0.25-3.15)
Studies that used access data280.68(0.60-0.77)0.51
Studies that used patient data120.78(0.60-1.03)
Incidental HD patients280.75(0.65-0.87)0.16
Prevalent HD patients60.63(0.52-0.77)
Primary patency at 36 months
Upper arm autogenous vs prosthetic80.87(0.66-1.14)0.78
Lower arm autogenous vs prosthetic40.80(0.48-1.34)
Studies that used access data130.65(0.54-0.78)0.08
Studies that used patient data50.83(0.67-1.01)
Incidental HD patients150.75(0.59-0.94)0.16
Prevalent HD patients60.59(0.48-0.73)
Secondary patency at 12 months
Upper arm autogenous vs prosthetic90.70(0.51-0.96)0.07
Lower arm autogenous vs prosthetic70.99(0.82-1.20)
Pediatric studies16.67(1.13-41.46)0.02
Adult studies220.82(0.62-0.99)
Studies that used access data180.82(0.66-0.97)0.45
Studies that used patient data50.95(0.68-1.32)
Incidental HD patients150.88(0.69-1.13)0.70
Prevalent HD patients40.97(0.63-1.50)
Secondary patency at 36 months
Upper arm autogenous vs prosthetic80.73(0.60-0.90)0.33
Lower arm autogenous vs prosthetic60.65(0.58-0.73)
Pediatric studies11.69(0.63-4.53)0.07
Adult studies180.67(0.60-0.76)
Studies that used access data160.67(0.59-0.75)0.80
Studies that used patient data30.71(0.46-1.09)
Incidental HD patients120.72(0.60-0.85)0.33
Prevalent HD patients40.61(0.46-0.81)

CI, Confidence interval; HD, hemodialysis; RR, relative risk.

Meta-regression revealed that neither study quality nor the length of study follow-up explained the between-study variability in patency reported across studies. In terms of diabetes status, the autogenous access was associated with longer patency36 and lower mortality63 than the prosthetic access in patients with and without diabetes. Hence, it appears that the presence of diabetes should not affect the choice of access.

Sensitivity analyses 

Sensitivity analyses are summarized in Table IV. The exclusion of studies in which the autogenous access was denatured homologous vein graft or saphenous vein grafts and the exclusion of studies that used administrative and billing databases to determine outcomes caused no significant change in any of the results.

Table IV. Sensitivity analysis
VariableStudies, No.RR (95% CI)
Death
Pooled estimate from all included studies270.76(0.67-0.86)
Excluding studies that used administrative data to assess outcomes250.71(0.60-0.84)
Excluding DHV and saphenous vein grafts from autogenous group250.75(0.65-0.86)
Primary patency at 12 months
Pooled estimate from all included studies410.71(0.64-0.80)
Excluding DHV and saphenous vein grafts from autogenous group390.70(0.62-0.78)
Excluding studies that used administrative data to assess outcomes380.70(0.62-0.80)
Adjustment for censoring applied300.72(0.62-0.84)
Adjustment for censoring not applied300.72(0.62-0.83)
Primary patency at 36 months
Pooled estimate from all included studies240.67(0.58-0.78)
Excluding studies that used administrative data to assess outcomes group220.68(0.58-0.81)
Adjustment for censoring applied200.73(0.59-0.90)
Adjustment for censoring not applied200.72(0.58-0.90)
Secondary patency at 12 months
Pooled estimate from all included studies240.84(0.71-1.00)
Excluding DHV and saphenous vein grafts from autogenous group220.84(0.69-1.02)
Excluding studies that used administrative data to assess outcomes220.83(0.67-1.03)
Adjustment for censoring applied210.84(0.70-1.00)
Adjustment for censoring not applied210.83(0.70-0.99)
Secondary patency at 36 months
Pooled estimate from all included studies200.67(0.61-0.74)
Adjustment for censoring applied190.64(0.54-0.74)
Adjustment for censoring not applied190.63(0.55-0.73)

CI, Confidence interval; DHV, denatured homologous vein grafts; RR, relative risk.

Because the shortest and longest follow-up times for study participants, which are the key variables in the adjustment for censoring of time-to-event data reported in graphic form, were either not reported or were similar in both study arms, adjustments for censoring were either not feasible or led to proportionate decrements of the sizes of both study arms, slightly widening the CIs without affecting the estimates of RR for any of the outcomes examined or their statistical significance (data not shown).

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Discussion 

We conducted a systematic review and meta-analyses to compare the autogenous and prosthetic accesses for chronic hemodialysis in terms of patient-important outcomes. We found that very low-quality evidence103 with significant heterogeneity suggests that the autogenous access of hemodialysis is superior to the prosthetic access in terms of the risks of death, access infection, and primary and secondary patency. Overall, there were insufficient data to identify a subgroup to which the overall conclusions do not apply, although subgroup analyses were underpowered.

Limitations and strengths 

Although systematic reviews and meta-analyses comparing autogenous vs prosthetics accesses exist, 6, 10 to our knowledge this is the first comprehensive review to assess patient-important outcomes other than patency. Efforts to reduce bias such as author contact, a review of the literature by two independent reviewers, and explicit quality assessment strengthen inferences from this review.

The main limitation of this review is the nonrandomized design of most of the included studies, which meant that the choice of access type was based on surgeons' preference, patients' comorbidities, and other unmeasured yet potentially important confounders. Although this inherent bias in observational studies can be remedied to some extent by controlling for factors that can affect study outcomes in either selecting cohorts or in analysis, we found that many studies did not control for these factors, rendering the cohort that received prosthetic access to include more patients with diabetes, patients with peripheral vascular disease, and older patients. This bias in selection has likely overestimated the benefit noted in patients who received the autogenous access. Moreover, the proportion of studies that contributed to each of the outcomes in this review was low; thus, reporting bias has likely affected the benefits noted with autogenous access placaement.104

Other limitations relate to extracting survival data from graphs and to the inconsistency of the taxonomy in the included studies, which underscores the need for standardized nomenclature.12 In addition, one study33 could not be retrieved and was extracted directly from a previously published systematic review.6

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Conclusions 

Although the available evidence is consistent with previous recommendations for using autogenous accesses for hemodialysis, the current review highlights that this inference is derived from very low-quality evidence. That is, large studies with better protection against bias—preferably randomized trials measuring patient important outcomes—are necessary to make recommendations with confidence because these may substantially change the estimates reported here. Patient and surgeon preferences, cost considerations, and clinical circumstances should inform the choice of access for specific patients. The accompanying practice guideline document includes the practical implication of this evidence from the standpoint of the expert members of the committee of the Society for Vascular Surgery.

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Author contributions 


Conception and design: MHM, AS, AD, PE, VM

Analysis and interpretation: MHM, VM

Data collection: MHM, ME, AS, GM, AR, DF, EC, FM, MM, DV, ZE, MT, PE

Writing the article: MHM, ME, AS, GM, AR, DF, EC, FM, MM, DV, ZE, AD, PE, VM

Critical revision of the article: MHM, ME, AS, GM, AR, DF, EC, FM, MM, DV, ZE, AD, PE, VM, MT

Final approval of the article: MHM, ME, AS, GM, AR, DF, EC, FM, MM, DV, ZE, AD, PE, VM, MT

Statistical analysis: MHM

Obtained funding: VM

Overall responsibility: MHM

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References 

  1. Huber TS, Buhler AG, Seeger JM. Evidence-based data for the hemodialysis access surgeon. Semin Dial. 2004;17:217–223
  2. Huber TS, Carter JW, Carter RL, Seeger JM. Patency of autogenous and polytetrafluoroethylene upper extremity arteriovenous hemodialysis accesses: a systematic review. J Vasc Surg. 2003;38:1005–1011
  3. Anonymous. NKF-KDOQI Clinical Practice Guidelines and clinical practice recommendations for Vascular Access, update 2006. Am J Kidney Dis. 2006;48(suppl 1):S177–S247
  4. Pisoni RL, Young EW, Dykstra DM, Greenwood RN, Hecking E, Gillespie B, et al. Vascular access use in Europe and the United States: results from the DOPPS. Kidney Int. 2002;61:305–316
  5. Astor BC, Coresh J, Powe NR, Eustace JA, Klag MJ. Relation between gender and vascular access complications in hemodialysis patients. Am J Kidney Dis. 2000;36:1126–1134
  6. Lazarides MK, Georgiadis GS, Antoniou GA, Staramos DN. A meta-analysis of dialysis access outcome in elderly patients. J Vasc Surg. 2007;45:420–426
  7. Leapman SB, Boyle M, Pescovitz MD, Milgrom ML, Jindal RM, Filo RS. The arteriovenous fistula for hemodialysis access: gold standard or archaic relic?. Am Surg. 1996;62:652–656discussion 656-7
  8. Diskin CJ, Stokes TJ, Panus LW, Thomas J, Lock S. The importance of timing of surgery for hemodialysis vascular access thrombectomy. Nephron. 1997;75:233–237
  9. Hakaim AG, Scott TE. Durability of early prosthetic dialysis graft cannulation: results of a prospective, nonrandomized clinical trial. J Vasc Surg. 1997;25:1002–1005discussion 1005-6
  10. Rooijens PP, Tordoir JH, Stijnen T, Burgmans JP, Smet de AA, Yo TI. Radiocephalic wrist arteriovenous fistula for hemodialysis: meta-analysis indicates a high primary failure rate. Eur J Vasc Endovasc Surg. 2004;28:583–589
  11. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting (Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group). JAMA. 2000;283:2008–2012
  12. Sidawy AN, Gray R, Besarab A, Henry M, Ascher E, Silva M, et al. Recommended standards for reports dealing with arteriovenous hemodialysis accesses. J Vasc Surg. 2002;35:603–610
  13. Wells G, Shea B, O'Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.htmAccessed: Feb 15, 2007
  14. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–188
  15. Higgins J, Thompson S, Deeks J, Altman D. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–560
  16. Parmar MK, Torri V, Stewart L. Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints. [Erratum appears in Stat Med 2004;23:1817] Stat Med. 1998;17:2815–2834
  17. Haimov M, Burrows L, Schanzer H. Experience with arterial substitutes in the construction of vascular access for hemodialysis. J Cardiovasc Surg. 1980;21:149–154
  18. Mangiarotti G, Segoloni GP, Vercellone A. Experience with 351 prosthetic vascular accesses for chronic dialysis. Life Support Syst. 1983;1(suppl 1):375–378
  19. Tordoir JH, Kwan TS, Herman JM, Carol EJ, Jakimowicz JJ. Primary and secondary access surgery for haemodialysis with the Brescia-Cimino fistula and the polytetrafluoroethylene (PTFE) graft. Neth J Surg. 1983;35:8–12
  20. Louridas G, Botha JR, Levien L. Vascular access for haemodialysis - experience at Johannesbrug Hospital. S Afr Med J. 1984;66:637–640
  21. Winsett OE, Wolma FJ. Complications of vascular access for hemodialysis. South Med J. 1985;78:513–517
  22. Kherlakian GM, Roedersheimer LR, Arbaugh JJ, Newmark KJ, King LR. Comparison of autogenous fistula versus expanded polytetrafluoroethylene graft fistula for angioaccess in hemodialysis. Am J Surg. 1986;152:238–243
  23. Zibari GB, Rohr MS, Landreneau MD, Bridges RM, DeVault GA, Petty FH, et al. Complications from permanent hemodialysis vascular access. Surgery. 1988;104:681–686
  24. Filiptsev PIa, Moǐǐsiuk IaG, Luk'ianov IuV. Use of an autovenous transplant, polytetrafluoroethylene prosthesis and human umbilical vein bioprosthesis for creating an arteriovenous fistula for programmed hemodialysis. [Russian] Vestn Khir Im I I Grek. 1989;143:36–38
  25. Nazzal MMS, Neglen P, Naseem J, Christenson JT, Al-Hassan HK. The brachiocephalic fistula: A successful secondary vascular access procedure. Vasa. 1990;19:326–329
  26. Sands J, Young S, Miranda C. The effect of Doppler flow screening studies and elective revisions on dialysis access failure. ASAIO J. 1992;38:M524–M527
  27. Churchill DN, Taylor DW, Cook RJ, LaPlante P, Barre P, Cartier P, et al. Canadian hemodialysis morbidity study. Am J Kidney Dis. 1992;19:214–234
  28. Tang IY, Vrahnos D, Valaitis D, Lau AH. Vascular access thrombosis during recombinant human erythropoietin therapy. ASAIO J. 1992;38:M528–M531
  29. Sanabia J, Polo JR, Morales MD, Canals MJ, Polo J, Serantes A. Microsurgery in gaining paediatric vascular access for haemodialysis. Microsurgery. 1993;14:276–279
  30. Taylor B, Sigley RD, May KJ. Fate of infected and eroded hemodialysis grafts and autogenous fistulas. Am J Surg. 1993;165:632–636
  31. Al-Wakeel J, Huraib S, Mitwalli A, Abu-Aisha H, Mofti AA, Faqih S, et al. Hemodialysis vascular access and complications. Vasc Surg. 1994;28:107–113
  32. Bender MH, Bruyninckx CM, Gerlag PG. The brachiocephalic elbow fistula: a useful alternative angioaccess for permanent hemodialysis. [see comment] J Vasc Surg. 1994;20:808;–3
  33. Chalabi L, Florence P, Chouzenoux R, Hoa B, Maurice F, Nguyen C, et al. What is to be done in the absence of a superficial venous network compatible with the creation of an arteriovenous shunt?. [French] Nephrologie. 1994;15:153–155
  34. Coburn MC, Carney WI. Comparison of basilic vein and polytetrafluoroethylene for brachial arteriovenous fistula. J Vasc Surg. 1994;20:896–902discussion 903-894
  35. Riordan S, Frawley J, Gray L, Niesche J. Primary access surgery for long-term haemodialysis. Aust N Z J Surg. 1994;64:763–767
  36. Chazan JA, London MR, Pono LM. Long-term survival of vascular accesses in a large chronic hemodialysis population. Nephron. 1995;69:228–233
  37. Kim YS, Yang CW, Jin DC, Ahn SJ, Chang YS, Yoon YS, et al. Comparison of peritoneal catheter survival with fistula survival in hemodialysis. Perit Dial Int. 1995;15:147–151
  38. Sands JJ, Miranda CL. Prolongation of hemodialysis access survival with elective revision. Clin Nephrol. 1995;44:329–333
  39. Tedoriya T, Urayama H, Katada S, Watanabe Y. A survey of vascular access for hemodialysis. Vasc Surg. 1995;29:123–127
  40. Vaccaro F, Pagano A, Romano M. Vascular accesses for hemodialysis: our experience for a period of three years. [Italian] Chirurgia. 1995;8:222–225
  41. Enzler MA, Rajmon T, Lachat M, Largiader F. Long-term function of vascular access for hemodialysis. Clin Transplant. 1996;10:511–515
  42. Herzig R, Florek HJ. Vascular surgical aspects of operative procedures for hemodialysis access. [German] Gefasschirurgie. 1997;2:144–149
  43. Hodges TC, Fillinger MF, Zwolak RM, Walsh DB, Bech F, Cronenwett JL. Longitudinal comparison of dialysis access methods: risk factors for failure. J Vasc Surg. 1997;26:1009–1019
  44. Miller A, Holzenbein TJ, Gottlieb MN, Sacks BA, Lavin PT, Goodman WS, et al. Strategies to increase the use of autogenous arteriovenous fistula in end-stage renal disease. Ann Vasc Surg. 1997;11:397–405
  45. Sparks SR, VanderLinden JL, Gnanadev DA, Smith JW, Bunt TJ. Superior patency of perforating antecubital vein arteriovenous fistulae for hemodialysis. Ann Vasc Surg. 1997;11:165–167
  46. Woods JD, Turenne MN, Strawderman RL, Young EW, Hirth RA, Port FK, et al. Vascular access survival among incident hemodialysis patients in the United States. Am J Kidney Dis. 1997;30:50–57
  47. Bay WH, Henry ML, Lazarus JM, Lew NL, Ling J, Lowrie EG. Predicting hemodialysis access failure with color flow Doppler ultrasound. Am J Nephrol. 1998;18:296–304
  48. Miranda CL, Sands JJ. Flow volumes as a predictor of hemodialysis access failure. J Vasc Technol. 1998;22:73–76
  49. Berardinelli L, Vegeto A. Lessons from 494 permanent accesses in 348 haemodialysis patients older than 65 years of age: 29 years of experience. Nephrol Dial Transplant. 1998;13(suppl 7):73–77
  50. Bosman PJ, Blankestijn PJ, van der Graaf Y, Heintjes RJ, Koomans HA, Eikelboom BC. A comparison between PTFE and denatured homologous vein grafts for haemodialysis access: a prospective randomised multicentre trial. Eur J Vasc Endovasc Surg. 1998;16:126–132
  51. Cante P, Bottet P, Ryckelynck JP, Roch BL, Levaltier B, Lobbedez T, et al. Distal vascular access for chronic hemodialysis in patients over 65 years of age (Surgical results). [French] Prog Urol. 1998;8:83–88
  52. Jenkins AM, Buist TA, Glover SD. Medium-term follow-up of forty autogenous vein and forty polytetrafluoroethylene (Gore-Tex) grafts for vascular access. Surgery. 1980;88:667–672
  53. Matsuura JH, Rosenthal D, Clark M, Shuler FW, Kirby L, Shotwell M, et al. Transposed basilic vein versus polytetrafluorethylene for brachial- axillary arteriovenous fistulas. Am J Surg. 1998;176:219–221
  54. Obialo CI, Robinson T, Brathwaite M. Hemodialysis vascular access: Variable thrombus-free survival in three subpopulations of black patients. Am J Kidney Dis. 1998;31:250–256
  55. Silva MB, Hobson RW, Pappas PJ, Jamil Z, Araki CT, Goldberg MC, et al. A strategy for increasing use of autogenous hemodialysis access procedures: impact of preoperative noninvasive evaluation. J Vasc Surg. 1998;27:302–307
  56. Wang EJ, Schneditz D, Nepomuceno C, Lavarias V, Martin K, Morris AT, et al. Predictive value of access blood flow in detecting access thrombosis. ASAIO J. 1998;44:M555–M558
  57. Agarwal R, Davis JL. Monitoring interposition graft venous pressures at higher blood-flow rates improves sensitivity in predicting graft failure. Am J Kidney Dis. 1999;34:212–217
  58. Turnbull RG, Lewis GM, Karim MA, Taylor DC, Salvian AJ, Chambers GK, et al. Primary vascular access for chronic hemodialysis: a comparison of arteriovenous fistulae with PTFE grafts. Vasc Surg. 1999;33:51–57
  59. Ascher E, Gade P, Hingorani A, Mazzariol F, Gunduz Y, Fodera M, et al. Changes in the practice of angioaccess surgery: impact of dialysis outcome and quality initiative recommendations. J Vasc Surg. 2000;31:84–90
  60. Rodriguez JA, Armadans L, Ferrer E, Olmos A, Codina S, Bartolome J, et al. The function of permanent vascular access. Nephrol Dial Transplant. 2000;15:402–408
  61. Staramos DN, Lazarides MK, Tzilalis VD, Ekonomou CS, Simopoulos CE, Dayantas JN. Patency of autologous and prosthetic arteriovenous fistulas in elderly patients. Eur J Surg. 2000;166:777–781
  62. Brunori VFG, Zubani R, Movilli E, Gaggiotti M, Cancarini G, et al. Which vascular access for chronic hemodialysis in uremic elderly patients?. J Vasc Access. 2000;1:134–138
  63. Dhingra RK, Young EW, Hulbert-Shearon TE, Leavey SF, Port FK. Type of vascular access and mortality in U.S. hemodialysis patients. Kidney Int. 2001;60:1443–1451
  64. Gibson KD, Caps MT, Kohler TR, Hatsukami TS, Gillen DL, Aldassy M, et al. Assessment of a policy to reduce placement of prosthetic hemodialysis access. Kidney Int. 2001;59:2335–2345
  65. Gibson KD, Gillen DL, Caps MT, Kohler TR, Sherrard DJ, Stehman-Breen CO. Vascular access survival and incidence of revisions: a comparison of prosthetic grafts, simple autogenous fistulas, and venous transposition fistulas from the United States Renal Data System Dialysis Morbidity and Mortality Study. [see comment] J Vasc Surg. 2001;34:694–700
  66. Oliver MJ, McCann RL, Indridason OS, Butterly DW, Schwab SJ. Comparison of transposed brachiobasilic fistulas to upper arm grafts and brachiocephalic fistulas. Kidney Int. 2001;60:1532–1539
  67. Dixon BS, Novak L, Fangman J. Hemodialysis vascular access survival: upper-arm native arteriovenous fistula. Am J Kidney Dis. 2002;39:92–101
  68. Lawrence C, Chow J, Suranyi M. Factors affecting haemodialysis-access survival in a single centre retrospective cohort study. Nephrology. 2002;7:72–76
  69. Pastan S, Soucie JM, McClellan WM. Vascular access and increased risk of death among hemodialysis patients. Kidney Int. 2002;62:620–626
  70. Ridao-Cano N, Polo JR, Polo J, Perez-Garcia R, Sanchez M, Gomez-Campdera FJ. Vascular access for dialysis in the elderly. Blood Purif. 2002;20:563–568
  71. Saxena AK, Panhotra BR, Naguib M, Sundaram DS, Venkateshappa CK, Wahid U, et al. The impact of achieving the target goal for AV fistulas, as set by NKF-DOQI, on Staphylococcus aureus septicemia. Dial Transplant. 2002;31:16–24
  72. Sheth RD, Brandt ML, Brewer ED, Nuchtern JG, Kale AS, Goldstein SL. Permanent hemodialysis vascular access survival in children and adolescents with end-stage renal disease. Kidney Int. 2002;62:1864–1869
  73. Valentine RJ, Bouch CW, Scott DJ, Li S, Jackson MR, Modrall JG, et al. Do preoperative finger pressures predict early arterial steal in hemodialysis access patients? (A prospective analysis). J Vasc Surg. 2002;36:351–356
  74. Johnson C. Preoperative and intraoperative predictors of vascular access outcome. In:  Henry ML editors. Vascular access for hemodialysis—VIII. Chicago, IL: Gore and Assoc and Precept Press; 2002;p. 143–156
  75. Baaran O, Karakayali H, Emirolu R, Belli S, Haberal M. Complications and long-term follow-up of 4416 vascular access procedures. Transplant Proc. 2003;35:2578–2579
  76. Cernadas MR, Grandjean M, Tosi MA. Vascular access patency and complications: a comparison of brachiobasilic AV fistulas and PTFE brachioaxillary bridge AV fistulas in hemodialysis patients. Dial Transplant. 2003;32:694
  77. Choi HM, Lal BK, Cerveira JJ, Padberg FT, Silva MB, et al. Durability and cumulative functional patency of transposed and nontransposed arteriovenous fistulas. J Vasc Surg. 2003;38:1206–1212
  78. Culp K, Flanigan M, Taylor L, Rothstein M. Vascular access thrombosis in new hemodialysis patients. Am J Kidney Dis. 1995;26:341–346
  79. Fisher CM, Neale ML. Outcome of surgery for vascular access in patients commencing haemodialysis. [see comment] Eur J Vasc Endovasc Surg. 2003;25:342–349
  80. Shenoy S, Miller A, Petersen F, Kirsch WM, Konkin T, Kim P, et al. A multicenter study of permanent hemodialysis access patency: beneficial effect of clipped vascular anastomotic technique. J Vasc Surg. 2003;38:229–235
  81. Xue JL, Dahl D, Ebben JP, Collins AJ. The association of initial hemodialysis access type with mortality outcomes in elderly medicare ESRD patients. Am J Kidney Dis. 2003;42:1013–1019
  82. Yu A, Egberg N, Jacobson SH. Haemostatic complications in haemodialysis patients: effect of type of vascular access and dialysis filter. Scand J Clin Lab Invest. 2003;63:127–133
  83. Iorio BRD, Bellizzi V, Cillo N, Cirillo M, Avella F, Andreucci VE, et al. Vascular access for hemodialysis: the impact on morbidity and mortality. J Nephrol. 2004;17:19–25
  84. Hazinedaroglu SM, Tuzuner A, Ayli D, Demirer S, Duman N, Yerdel MA. Femoral vein transposition versus femoral loop grafts for hemodialysis: a prospective evaluation. Transplant Proc. 2004;36:65–67
  85. Kizilisik AT, Kim SB, Nylander WA, Shaffer D. Improvements in dialysis access survival with increasing use of arteriovenous fistulas in a Veterans Administration medical center. Am J Surg. 2004;188:614–616
  86. Perera GB, Mueller MP, Kubaska SM, Wilson SE, Lawrence PF, Fujitani RM. Superiority of autogenous arteriovenous hemodialysis access: maintenance of function with fewer secondary interventions. Ann Vasc Surg. 2004;18:66–73
  87. Polkinghorne KR, McDonald SP, Atkins RC, Kerr PG. Vascular access and all-cause mortality: a propensity score analysis. J Am Soc Nephrol. 2004;15:477–486
  88. Akoh JA, Sinha S, Dutta S, Opaluwa AS, Lawson H, Shaw JF, et al. A 5-year audit of haemodialysis access. Int J Clin Prac. 2005;59:847–851
  89. Astor BC, Eustace JA, Powe NR, Klag MJ, Fink NE, Coresh J. Type of vascular access and survival among incident hemodialysis patients: the choices for healthy outcomes in caring for ESRD (CHOICE) study. J Am Soc Nephrol. 2005;16:1449–1455
  90. Fitzgerald JT, Schanzer A, McVicar JP, Chin AI, Perez RV, Troppmann C. Upper arm arteriovenous fistula versus forearm looped arteriovenous graft for hemodialysis access: a comparative analysis. Ann Vasc Surg. 2005;19:843–850
  91. Kawecka A, Debska-slizien A, Prajs J, Krol E, Zdrojewski Z, Przekwas M, et al. Remarks on surgical strategy in creating vascular access for hemodialysis: 18 years of one center's experience. Ann Vasc Surg. 2005;19:590–598
  92. Manns B, Tonelli M, Yilmaz S, Lee H, Laupland K, Klarenbach S, et al. Establishment and maintenance of vascular access in incident hemodialysis patients: a prospective cost analysis. J Am Soc Nephrol. 2005;16:201–209
  93. Ramage IJ, Bailie A, Tyerman KS, McColl JH, Pollard SG, Fitzpatrick MM. Vascular access survival in children and young adults receiving long-term hemodialysis. Am J Kidney Dis. 2005;45:708–714
  94. Rooijens PP, Burgmans JP, Yo TI, Hop WC, de Smet AA, van den Dorpel MA, et al. Autogenous radial-cephalic or prosthetic brachial-antecubital forearm loop AVF in patients with compromised vessels? (A randomized, multicenter study of the patency of primary hemodialysis access). see comment J Vasc Surg. 2005;42:481–487
  95. Ates A, Ozyazicioglu A, Yekeler I, Ceviz M, Erkut B, Karapolat S, et al. Primary and secondary patency rates and complications of upper extremity arteriovenous fistulae created for hemodialysis. Tohoku J Exp Med. 2006;210:91–97
  96. Roca-Tey R, Samon R, Ibrik O, Martinez-Cercos R, Viladoms J. Functional vascular access evaluation after elective intervention for stenosis. J Vasc Access. 2006;7:29–34
  97. Woo K, Farber A, Doros G, Killeen K, Kohanzadeh S. Evaluation of the efficacy of the transposed upper arm arteriovenous fistula: a single institutional review of 190 basilic and cephalic vein transposition procedures. J Vasc Surg. 2007;46:94–101
  98. Keuter X, De Smet A, Kessels A, van der Sande F, Welten R, Tordoir J. A randomized multicenter study of the outcome of brachial-basilic arteriovenous fistula and prosthetic brachial-antecubital forearm loop as vascular access for hemodialysis. J Vasc Surg. 2008;47:395–401
  99. Egin AA, Shabanov VI, Chukhrienko ST, Koshev VI, Petrov ES. Formation of a vascular access in patients with terminal chronic renal insufficiency for hemodialysis based on the new general theory of circulation. [Russian] Angiol Sosud Khir. 2003;9:119–121
  100. Giorcelli G, Tricerri A, Vacha G. 20 years' experience with “difficult” vascular access. [Italian] Minerva Urol Nefrol. 1998;50:29–33
  101. Keller F, Loewe HJ, Bauknecht KJ, Schwarz A, Offermann G. Cumulative functional rates of orthoptic dialysis fistulas and interposition grafts. [German] Dtsch Med Wochenschr. 1988;113:332–336
  102. Rodriguez JA, Ferrer E, Olmos A, Codina S, Borrellas J, Piera L. Analysis of the survival of permanent vascular access ports. [Spanish] Nefrologia. 2001;21:260–273
  103. Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, et al. Grading quality of evidence and strength of recommendations. BMJ. 2004;328:1490
  104. Furukawa TA, Watanabe N, Omori IM, Montori VM, Guyatt GH. Association between unreported outcomes and effect size estimates in Cochrane meta-analyses. JAMA. 2007;297:468–470

 This review was funded by a contract from the Society for Vascular Surgery.

 STATEMENT OF CONFLICT OF INTEREST: These authors report that they have no conflicts of interest with the sponsor of this supplement article or products discussed in this article.

PII: S0741-5214(08)01395-5

doi:10.1016/j.jvs.2008.08.044

Journal of Vascular Surgery
Volume 48, Issue 5, Supplement , Pages S34-S47, November 2008

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