对于外科医生来说,确定头静脉通常无法进入的血液透析患者的适当血管通路是具有挑战性的。该研究的目的是比较血液透析患者的转座动静脉瘘(tAVF)和动静脉移植物(AVG)之间的并发症和通畅率。研究是从PubMed招募的,科克伦图书馆,EMBASE,科学网数据库,并审查从开始日期到2021年9月2日的相关研究的参考清单。使用统计工具ReviewManagerversion5.3(CochraneCollaboration,伦敦,英国)。I2>50%被定义为高度异质性,然后使用随机效应模型。否则,采用固定效应模型。使用其95%置信区间(95%CI)的赔率比。33项试验(26项回顾性研究,四项随机对照试验,两项前瞻性试验,和一项对照比较研究),在我们的分析中确定了6430名参与者。结果表明,tAVF的血栓形成率较低(103/1184(8.69%)比257/1367(18.80%);I2=45%;95%CI,0.34(0.26,0.45))和感染率(43/2031(2.12%)比180/2147(8.38%);I2=0%;95%CI,0.20(0.14,0.30))。原发性通畅率显着提高,二级通畅率,在tAVF中发现了随访期间的主要辅助通畅率。然而,AVG组的失败率和血肿发生率明显较低。没有证据显示总死亡率,偷窃综合征,在tAVF中动脉瘤减少。我们的结果表明,tAVF对于头静脉无法进入的血液透析患者是一种有前途的血管通路技术。我们的数据显示tAVF的血栓形成较少,感染风险,与AVG相比,通畅率更好。然而,需要更多关注的是转位动静脉瘘成熟和血肿。
It is challenging for a surgeon to determine the appropriate vascular access for hemodialysis patients whose cephalic vein is usually inaccessible. The purpose of the study is to compare the complications and patency rates between transposed arteriovenous fistulas (tAVF) and arteriovenous graft (AVG) for the hemodialysis patients. Studies were recruited from PubMed, Cochrane library, EMBASE, the web of science databases, and reviewing reference lists of related studies from the inception dates to September 2, 2021. Statistical analyses were conducted using the statistical tool
Review Manager version5.3 (Cochrane Collaboration, London, UK). I2 > 50% was defined as a high degree of heterogeneity, and then a random-effects model was used. Otherwise, the fixed-effects model was used. Odds ratio with its 95% confidence interval (95% CI) was used. Thirty-three trials (26 retrospective studies, four randomized controlled trials, two prospective trials, and one controlled-comparative study) with 6430 enrolled participants were identified in our analysis. The results showed that tAVF was accompanied with lower thrombosis rate (103/1184 (8.69%) vs 257/1367 (18.80%); I2 = 45%; 95% CI, 0.34 (0.26, 0.45)) and infection rate (43/2031 (2.12%) vs 180/2147 (8.38%); I2 = 0%; 95% CI, 0.20 (0.14, 0.30)) than arteriovenous graft. The significantly better primary patency rates, secondary patency rates, and primary assisted patency rates during follow-up were found in tAVF. However, the failure rate and the prevalence of hematoma were significantly lower in AVG group. No evidence showed the rate of overall mortality, steal syndrome, and aneurysm reduced in tAVF. Our results showed that tAVF is a promising vascular access technique for hemodialysis patients whose cephalic vein is inaccessible. Our data showed that tAVF has less thrombosis, infection risk, and better patency rates when compared with AVG. However, more attentions need to be paid to transposed arteriovenous fistulas maturation and hematoma.