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Title: A Meta-analysis of Randomized Trials Comparing Surgery versus Endovascular Therapy for Thrombosed Arteriovenous Fistulas and Grafts in Hemodialysis

Abstract

Purpose. To carry out a systematic review of randomized trials comparing surgery vs. endovascular therapy for occluded fistulas and grafts. Methods. All randomized trials which compared surgery and endovascular therapy for occluded fistulas and grafts were retrieved from 1990 onwards. The following search terms were used: 'haemodialysis,' 'thrombosis,' 'arteriovenous fistula,' 'arteriovenous shunt,' 'end stage renal failure' on Medline and PubMed. The results of the pooled data were analysed by a fixed-effect model. Results. There were no randomized trials comparing surgery vs. endovascular therapy for native fistulas and vein grafts. Six randomized studies reporting on 573 occluded grafts were identified. Technical success, need for access line and primary patency at 30 days were similar between the two groups (odds ratio [OR] 1.40, 95 % confidence interval [CI] 0.91-2.14; OR 0.77, 95 % CI 0.44-1.34; and OR 1.15, 95 % CI 0.79-1.68, respectively). There was no significant difference in morbidity at 30 days between groups (OR 1.12, 95 % CI 0.67-1.86). There were no statistical difference between the two groups for 1 year primary patency (OR 2.08, 95 % CI 0.97-4.45). Primary assisted patency at 1 year was better with surgery (OR 3.03, 95 % CI 1.12-8.18) in a single study. Conclusion.more » Comparable results to surgery have been achieved with endovascular techniques for occluded prosthetic grafts for dialysis access. Long-term data comparing the two groups were lacking. Further trials designed to encompass variation in methods are warranted in order to obtain the best available evidence particularly for native fistulas.« less

Authors:
;  [1]; ;  [2];  [3];  [4];  [3]
  1. Central Manchester University Hospital Foundation Trust, Regional Vascular and Endovascular Unit (United Kingdom)
  2. Central Manchester University Hospital Foundation Trust, Department of Renal Medicine (United Kingdom)
  3. Central Manchester University Hospital Foundation Trust, Department of Radiology (United Kingdom)
  4. University of Aberdeen (United Kingdom)
Publication Date:
OSTI Identifier:
22113638
Resource Type:
Journal Article
Journal Name:
Cardiovascular and Interventional Radiology
Additional Journal Information:
Journal Volume: 36; Journal Issue: 3; Other Information: Copyright (c) 2013 Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0174-1551
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BIOMEDICAL RADIOGRAPHY; BYPASSES; DIALYSIS; DISEASE INCIDENCE; GRAFTS; KIDNEYS; SURGERY; THERAPY; VEINS

Citation Formats

Kuhan, G., E-mail: gkuhan@nhs.net, Antoniou, G. A., Nikam, M., Mitra, S., Farquharson, F., Brittenden, J., and Chalmers, N. A Meta-analysis of Randomized Trials Comparing Surgery versus Endovascular Therapy for Thrombosed Arteriovenous Fistulas and Grafts in Hemodialysis. United States: N. p., 2013. Web. doi:10.1007/S00270-013-0564-8.
Kuhan, G., E-mail: gkuhan@nhs.net, Antoniou, G. A., Nikam, M., Mitra, S., Farquharson, F., Brittenden, J., & Chalmers, N. A Meta-analysis of Randomized Trials Comparing Surgery versus Endovascular Therapy for Thrombosed Arteriovenous Fistulas and Grafts in Hemodialysis. United States. doi:10.1007/S00270-013-0564-8.
Kuhan, G., E-mail: gkuhan@nhs.net, Antoniou, G. A., Nikam, M., Mitra, S., Farquharson, F., Brittenden, J., and Chalmers, N. Sat . "A Meta-analysis of Randomized Trials Comparing Surgery versus Endovascular Therapy for Thrombosed Arteriovenous Fistulas and Grafts in Hemodialysis". United States. doi:10.1007/S00270-013-0564-8.
@article{osti_22113638,
title = {A Meta-analysis of Randomized Trials Comparing Surgery versus Endovascular Therapy for Thrombosed Arteriovenous Fistulas and Grafts in Hemodialysis},
author = {Kuhan, G., E-mail: gkuhan@nhs.net and Antoniou, G. A. and Nikam, M. and Mitra, S. and Farquharson, F. and Brittenden, J. and Chalmers, N.},
abstractNote = {Purpose. To carry out a systematic review of randomized trials comparing surgery vs. endovascular therapy for occluded fistulas and grafts. Methods. All randomized trials which compared surgery and endovascular therapy for occluded fistulas and grafts were retrieved from 1990 onwards. The following search terms were used: 'haemodialysis,' 'thrombosis,' 'arteriovenous fistula,' 'arteriovenous shunt,' 'end stage renal failure' on Medline and PubMed. The results of the pooled data were analysed by a fixed-effect model. Results. There were no randomized trials comparing surgery vs. endovascular therapy for native fistulas and vein grafts. Six randomized studies reporting on 573 occluded grafts were identified. Technical success, need for access line and primary patency at 30 days were similar between the two groups (odds ratio [OR] 1.40, 95 % confidence interval [CI] 0.91-2.14; OR 0.77, 95 % CI 0.44-1.34; and OR 1.15, 95 % CI 0.79-1.68, respectively). There was no significant difference in morbidity at 30 days between groups (OR 1.12, 95 % CI 0.67-1.86). There were no statistical difference between the two groups for 1 year primary patency (OR 2.08, 95 % CI 0.97-4.45). Primary assisted patency at 1 year was better with surgery (OR 3.03, 95 % CI 1.12-8.18) in a single study. Conclusion. Comparable results to surgery have been achieved with endovascular techniques for occluded prosthetic grafts for dialysis access. Long-term data comparing the two groups were lacking. Further trials designed to encompass variation in methods are warranted in order to obtain the best available evidence particularly for native fistulas.},
doi = {10.1007/S00270-013-0564-8},
journal = {Cardiovascular and Interventional Radiology},
issn = {0174-1551},
number = 3,
volume = 36,
place = {United States},
year = {2013},
month = {6}
}