PDF(Pubmed)
Abstract：
Arteriovenous grafts (AVGs) are an appropriate option for vascular access in certain hemodialysis patients. Expanded polytetrafluoroethylene (ePTFE) has become the dominant material for such grafts, due in part to innovations in graft design and surgical interventions to reduce complications and improve patency rates. Comprehensive evidence syntheses have not been conducted to update AVG performance in an era in which both access choice and ePTFE graft functioning may have changed. We conducted a systematic review and meta-analysis summarizing outcomes from recent studies of ePTFE AVGs in hemodialysis, following PRISMA standards. Literature searches were conducted in multiple databases to identify observational and interventional studies of AVG patency and infection risk. Primary, primary-assisted, and secondary patency rates were analyzed at 6, 12, 18, and 24 months postplacement. Kaplan-Meier graft survival plots were digitized to recreate individual patient-level data. Patency rates were pooled using a random effects model. We identified 32 studies meeting our selection criteria that were published from 2004 through 2019. A total of 38 study arms of ePTFE grafts were included, representing 3381 AVG accesses placed. The mean primary, primary-assisted, and secondary patency rates at 1 year were 41% (95% CI, 35% to 47%), 46% (95% CI, 41% to 51%), and 70% (95% CI, 64% to 75%), respectively. Mean 24-month patency rates were 28% (95% CI, 22% to 33%), 34% (95% CI, 27% to 41%), and 54% (95% CI, 47% to 61%), respectively. A high degree of heterogeneity across studies was observed. Overall risk of infection was not consistently reported, but among available studies the pooled estimate was 9% per patient-year (95% CI, 6% to 12%). This meta-analysis provides an up-to-date estimate of the performance of ePTFE AVGs, within the context of improved graft designs and improved interventional techniques.
摘要：
动静脉移植物（AVG）是某些血液透析患者血管通路的合适选择。膨胀聚四氟乙烯（ePTFE）已成为此类移植物的主要材料，部分原因是移植物设计和手术干预方面的创新，以减少并发症并提高通畅率。在访问选择和ePTFE移植物功能都可能发生变化的时代，尚未进行全面的证据综合来更新AVG性能。我们进行了系统评价和荟萃分析，总结了ePTFEAVGs在血液透析中的最新研究结果，遵循PRISMA标准。在多个数据库中进行文献检索，以确定AVG通畅性和感染风险的观察性和介入性研究。Primary,初级辅助，和二次通畅率在安置后6,12,18和24个月进行分析.将Kaplan-Meier移植物存活图数字化以重建个体患者水平的数据。使用随机效应模型汇集通畅率。我们确定了32项符合我们选择标准的研究，这些研究于2004年至2019年发表。共包括38个研究臂的ePTFE移植物，表示3381AVG访问放置。平均初级，初级辅助，1年的二次通畅率为41%（95%CI，35%至47%），46%（95%CI，41%至51%），和70%（95%CI，64%至75%），分别。平均24个月通畅率为28%（95%CI，22%至33%），34%（95%CI，27%至41%），和54%（95%CI，47%至61%），分别。观察到不同研究的高度异质性。总的感染风险并没有一致的报告，但在现有研究中,汇总估计值为每个患者-年9%(95%CI,6%~12%).这项荟萃分析提供了ePTFEAVGs性能的最新估计，在改进的移植物设计和改进的介入技术的背景下。
