Abstract：
Arteriovenous graft (AVG) is an alternative for hemodialysis (HD) patients with end-stage renal disease when their permanent vascular accesses fail. Since the last decades, the most widely used materials in these patients have been polytetrafluoroethylene (PTFE)-AVGs. Recently, several studies have reported that early cannulation (EC)-AVG can be an alternative to PTFE-AVG. This systematic review and meta-analysis aimed to compare the outcomes of EC-AVG and PTFE-AVG in HD patients. We searched the Ovid Embase, Ovid MEDLINE, and Cochrane Central Register of Controlled Trials for the relevant studies published from 01.01.2000 to 19.12.2022 by keywords and free words. All randomized controlled trials (RCTs) and observational cohort studies comparing EC-AVG with PTFE-AVG were included. Ten studies were included in analysis: one RCT, six retrospective cohort studies, and three prospective cohort studies. The results showed shorter cannulation intervals (four studies, 1116 participants: mean difference -23.62 days, 95% CI [-32.03, -15.21], p < 0.05) and less central venous catheter (CVC) usage (four studies, 733 participants: OR 0.20, 95% CI [0.04, 0.92], p < 0.05) for EC-AVG compared with PTFE-AVG, while comparable outcomes of primary patency (eight studies, 1712 participants: HR 0.89, 95% CI [0.70, 1.12]), primary assisted patency (five studies, 1355 participants: HR 1.13, 95% CI [0.70, 1.84]), secondary patency (nine studies, 1920 participants: HR 0.93, 95% CI [0.66, 1.31]), and infection risk (four studies, 640 participants: HR 1.12, 95% CI [0.48, 2.58]). When compared to PTFE-AVG in HD patients, EC-AVG seems to exhibit shorter cannulation intervals, less CVC usage, and comparable outcomes of graft patency, and infection risk.
摘要：
动静脉移植物（AVG）是患有终末期肾病的血液透析（HD）患者永久性血管通路失败的替代方法。自从过去几十年,这些患者中使用最广泛的材料是聚四氟乙烯（PTFE）-AVG。最近,多项研究报道，早期插管（EC）-AVG可以替代PTFE-AVG。本系统评价和荟萃分析旨在比较EC-AVG和PTFE-AVG在HD患者中的疗效。我们搜查了OvidEmbase,OvidMEDLINE,以及Cochrane中央对照试验登记册，用于从01.01.2000到19.12.2022通过关键词和自由词发表的相关研究。纳入比较EC-AVG与PTFE-AVG的所有随机对照试验（RCT）和观察性队列研究。分析包括10项研究：一项RCT，六项回顾性队列研究，和三项前瞻性队列研究。结果显示插管间隔较短(四项研究，1116名参与者：平均差-23.62天，95%CI[-32.03，-15.21]，p<0.05)和较少的中心静脉导管(CVC)使用(四项研究，733名参与者：或0.20，95%CI[0.04，0.92]，与PTFE-AVG相比，EC-AVG的p<0.05)，虽然原发性通畅性的结果相当(8项研究，1712名参与者：HR0.89，95%CI[0.70，1.12])，初级辅助通畅(五项研究，1355名参与者：HR1.13，95%CI[0.70，1.84])，二级通畅(九项研究，1920名参与者：HR0.93，95%CI[0.66，1.31])，和感染风险(四项研究，640名参与者：HR1.12，95%CI[0.48，2.58]）。与HD患者的PTFE-AVG相比，EC-AVG似乎表现出较短的插管间隔，更少的CVC使用，和移植物通畅的可比结果，和感染风险。
