The Impact of Surgical Timing on Outcomes in Patients Undergoing Arteriovenous FistulaCreation for Hemodialysis. A Meta-analysis
Optimizing Outcomes: A Comprehensive Meta-Analysis of AVF Timing for Hemodialysis
DOI:
https://doi.org/10.69750/dmls.01.08.077Keywords:
Arteriovenous fistula, hemodialysis, surgical timing, vascular access, primary failure, postoperative complicationsAbstract
Background: Arteriovenous fistula (AVF) creation is the preferred method for vascular access in hemodialysis patients, offering better long-term patency, fewer complications, and lower infection rates compared to other options. However, the timing of AVF creation plays a critical role in determining outcomes. This meta-analysis examines the impact of surgical timing on AVF success, focusing on primary failure rates, maturation time, patency, and postoperative complications.
Objectives: We sought to evaluate whether the timing of AVF creation impacts outcomes in hemodialysis patients and to provide evidence-based recommendations for clinical practice.
Methods: Following PRISMA guidelines, a comprehensive meta-analysis was conducted from major databases (PubMed, Embase, Cochrane) until 2024 that included data. We selected studies based on defined criteria, and assessed for quality using the Newcastle-Ottawa Scale and Cochrane Risk of Bias tool. Primary failure rates, maturation time, primary and secondary patency and postoperative complications were analyzed as outcomes. Heterogeneity was addressed with random effects models, and subgroup analyses were carried out on the basis of patient characteristics.
Results: Early AVF creation (creating an AVF ≥ 6 months prior to dialysis initiation) was shown to reduced primary failure rate by 50%, shortened maturation time by 2 to 3 weeks and increase primary patency rates by up to 35%. Early AVF creation, on the other hand, was also accompanied by fewer postoperative complications, including infection and thrombosis, versus delayed AVF creation. Consistent benefits were seen for different patient profiles in subgroup analyses.
Conclusion: Early AVF creation is associated with superior outcomes, including lower failure rates, quicker maturation, and fewer complications. These findings support early AVF as the preferred practice in hemodialysis care, enhancing long-term patient outcomes and quality of care.
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References
Hajibandeh S, Burton H, Gleed P, Hajibandeh S, Wilmink T. Impact of arteriovenous fistulas versus arteriovenous grafts on vascular access performance in haemodialysis patients: A systematic review and meta-analysis. Vascular. 2021;30(6):1021-33.doi: 10.1177/17085381211041473
Almasri J, Alsawas M, Mainou M, Mustafa RA, Wang Z, Woo K, et al. Outcomes of vascular access for hemodialysis: A systematic review and meta-analysis. Journal of Vascular Surgery. 2016;64(1):236-43.doi: https://doi.org/10.1016/j.jvs.2016.01.053
Scholz SS, Vukadinović D, Lauder L, Ewen S, Ukena C, Townsend RR, et al. Effects of Arteriovenous Fistula on Blood Pressure in Patients With End‐Stage Renal Disease: A Systematic Meta‐Analysis. Journal of the American Heart Association. 2019;8(4):e011183.doi: 10.1161/JAHA.118.011183
Smith GE, Souroullos P, Cayton T, Harwood A, Carradice D, Chetter IC. A Systematic Review and Meta-Analysis of Systemic Intraoperative Anticoagulation during Arteriovenous Access Formation for Dialysis. The Journal of Vascular Access. 2015;17(1):1-5.doi: 10.5301/jva.5000484
Malik MH, Mohammed M, Kallmes DF, Misra S. Endovascular Versus Surgical Arteriovenous Fistulas: A Systematic Review and Meta-analysis. Kidney Medicine. 2022;4(3):100406.doi: https://doi.org/10.1016/j.xkme.2021.100406
Yan Wee IJ, Yap HY, Tang TY, Chong TT. A systematic review, meta-analysis, and meta-regression of the efficacy and safety of endovascular arteriovenous fistula creation. Journal of Vascular Surgery. 2020;71(1):309-17.e5.doi: https://doi.org/10.1016/j.jvs.2019.07.057
Kuhan G, Antoniou GA, Nikam M, Mitra S, Farquharson F, Brittenden J, et al. A Meta-analysis of Randomized Trials Comparing Surgery versus Endovascular Therapy for Thrombosed Arteriovenous Fistulas and Grafts in Hemodialysis. CardioVascular and Interventional Radiology. 2013;36(3):699-705.doi: 10.1007/s00270-013-0564-8
Jun Yan Wee I, Mohamed IH, Patel A, Choong AMTL. A systematic review and meta-analysis of one-stage versus two-stage brachiobasilic arteriovenous fistula creation. Journal of Vascular Surgery. 2018;68(1):285-97.doi: https://doi.org/10.1016/j.jvs.2018.03.428
Cerneviciute R, Sahebally SM, Ahmed K, Murphy M, Mahmood W, Walsh SR. Regional Versus Local Anaesthesia for Haemodialysis Arteriovenous Fistula Formation: A Systematic Review and Meta-Analysis. European Journal of Vascular and Endovascular Surgery. 2017;53(5):734-42.doi: https://doi.org/10.1016/j.ejvs.2017.01.025
Peralta R, Sousa L, Cristovão AF. Cannulation Technique of Vascular Access in Hemodialysis and the Impact on the Arteriovenous Fistula Survival: Systematic Review and Meta-Analysis. Journal of Clinical Medicine [Internet]. 2023; 12(18).doi: 10.3390/jcm12185946
Sun J-B, Liu C-C, Shen X, Chen Q, Xu C-L, Cui T-L. Percutaneous endovascular arteriovenous fistula: A systematic review and meta-analysis. Frontiers in Cardiovascular Medicine. 2022;9.doi: 10.3389/fcvm.2022.978285
Zhang D, Liang J, Yang Y. Features associated with arteriovenous fistula patency. A meta-analysis. Hemodialysis International.n/a(n/a).doi: https://doi.org/10.1111/hdi.13183
Ramanarayanan S, Sharma S, Swift O, Laws KR, Umar H, Farrington K. Systematic review and meta-analysis of preoperative interventions to support the maturation of arteriovenous fistulae in patients with advanced kidney disease. Nephrology Dialysis Transplantation. 2023;38(10):2330-9.doi: 10.1093/ndt/gfad040
Ismail A, Abushouk AI, Bekhet AH, Abunar O, Hassan O, Khamis AA, et al. Regional versus local anesthesia for arteriovenous fistula creation in end-stage renal disease: a systematic review and meta-analysis. The Journal of Vascular Access. 2017;18(3):177-84.doi: 10.5301/jva.5000683
Chan N, Wee I, Soong TK, Syn N, Choong AMTL. A systematic review and meta-analysis of surgical versus endovascular thrombectomy of thrombosed arteriovenous grafts in hemodialysis patients. Journal of Vascular Surgery. 2019;69(6):1976-88.e7.doi: https://doi.org/10.1016/j.jvs.2018.10.102
Rooijens PPGM, Tordoir JHM, Stijnen T, Burgmans JPJ, Smet de AAEA, Yo TI. Radiocephalic Wrist Arteriovenous Fistula for Hemodialysis: Meta-analysis Indicates a High Primary Failure Rate. European Journal of Vascular and Endovascular Surgery. 2004;28(6):583-9.doi: https://doi.org/10.1016/j.ejvs.2004.08.014
Koudounas G, Giannopoulos S, Volteas P, Aljobeh A, Karkos C, Virvilis D. Arteriovenous Fistula Maturation in Patients with Ipsilateral Versus Contralateral Tunneled Dialysis Catheter: A Systematic Review and Meta-analysis. Annals of Vascular Surgery. 2024;103:14-21.doi: https://doi.org/10.1016/j.avsg.2023.11.048
Bashar K, Healy DA, Elsheikh S, Browne LD, Walsh MT, Clarke-Moloney M, et al. One-Stage vs. Two-Stage Brachio-Basilic Arteriovenous Fistula for Dialysis Access: A Systematic Review and a Meta-Analysis. PLOS ONE. 2015;10(3):e0120154.doi: 10.1371/journal.pone.0120154
Tordoir JHM, Zonnebeld N, van Loon MM, Gallieni M, Hollenbeck M. Surgical and Endovascular Intervention for Dialysis Access Maturation Failure During and After Arteriovenous Fistula Surgery: Review of the Evidence. European Journal of Vascular and Endovascular Surgery. 2018;55(2):240-8.doi: https://doi.org/10.1016/j.ejvs.2017.12.001
Shu P, Wang X, Wen Z, Li C, Luo Y, Xu F. The effect of multiple single cannulation technique on complications of arteriovenous fistulae: A meta-analysis. Medicine. 2024;103(38):e39748.doi: 10.1097/md.0000000000039748
Tang Q-h, Yang H, Chen J, Lin Q-n, Qin Z, Hu M, et al. Comparison between transposed arteriovenous fistulas and arteriovenous graft for the hemodialysis patients: A meta-analysis and systematic review. The Journal of Vascular Access. 2024;25(2):369-89.doi: 10.1177/11297298221102875
Bashar K, Medani M, Bashar H, Ahmed K, Aherne T, Moloney T, et al. End-To-Side versus Side-To-Side Anastomosis in Upper Limb Arteriovenous Fistula for Dialysis Access: A Systematic Review and a Meta-Analysis. Annals of Vascular Surgery. 2018;47:43-53.doi: https://doi.org/10.1016/j.avsg.2017.07.036
Wen M, Li Z, Li J, Zhou W, Liu Y, Liu H, et al. Risk Factors for Primary Arteriovenous Fistula Dysfunction in Hemodialysis Patients: A Retrospective Survival Analysis in Multiple Medical Centers. Blood Purification. 2019;48(3):276-82.doi: 10.1159/000500045
Gao C, Weng C, He C, Xu J, Yu L. Comparison of regional and local anesthesia for arteriovenous fistula creation in end-stage renal disease: a systematic review and meta-analysis. BMC Anesthesiology. 2020;20(1):219.doi: 10.1186/s12871-020-01136-1
Lin S-J, Tung C-W, Hsu Y-C, Shih Y-H, Wu Y-L, Chou T-C, et al. The Prognostic Significance of Puncture Timing to Survival of Arteriovenous Fistulas in Hemodialysis Patients: A Multicenter Retrospective Cohort Study. Journal of Clinical Medicine [Internet]. 2019; 8(2).doi: 10.3390/jcm8020247
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