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

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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

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.

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References

  1. Navuluri R, Regalado S (2009) The KDOQI 2006 vascular access update and Fistula First program synopsis. Semin Intervent Radiol 26:122–124

    Article  PubMed  Google Scholar 

  2. Green LD, Lee DS, Kucey DS (2002) A metaanalysis comparing surgical thrombectomy, mechanical thrombectomy, and pharmacomechanical thrombolysis for thrombosed dialysis grafts. J Vasc Surg 36:939–945

    Article  PubMed  Google Scholar 

  3. Turmel-Rodrigues L (2003) Application of percutaneous mechanical thrombectomy in autogenous fistulae. Tech Vasc Interv Radiol 6:42–48

    Article  PubMed  Google Scholar 

  4. Tordoir JH, Bode AS, Peppelenbosch N et al (2009) Surgical or endovascular repair of thrombosed dialysis vascular access: is there any evidence? J Vasc Surg 50:953–956

    Article  PubMed  Google Scholar 

  5. Besarab A, Dinwiddie L (2006) Changes noted to KDOQI guidelines for vascular access. Nephrol News Issues 20:36

    PubMed  Google Scholar 

  6. Gray RJ, Sacks D, Martin LG, Trerotola SO (1999) Reporting standards for percutaneous interventions in dialysis access. Technology Assessment Committee. J Vasc Interv Radiol 10:1405–1415

    Article  PubMed  CAS  Google Scholar 

  7. Jadad AR, Moore RA, Carroll D et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12

    Article  PubMed  CAS  Google Scholar 

  8. Marston WA, Criado E, Jaques PF et al (1997) Prospective randomized comparison of surgical versus endovascular management of thrombosed dialysis access grafts. J Vasc Surg 26:373–380

    Article  PubMed  CAS  Google Scholar 

  9. Uflacker R, Rajagopalan PR, Selby JB, Hannegan C, Investigators of the Clinical Trial Sponsored by Microvena Corporation (2004) Thrombosed dialysis access grafts: randomized comparison of the Amplatz thrombectomy device and surgical thromboembolectomy. Eur Radiol 14:2009–2014

    Article  PubMed  Google Scholar 

  10. Vesely TM, Idso MC, Audrain J et al (1996) Thrombolysis versus surgical thrombectomy for the treatment of dialysis graft thrombosis: pilot study comparing costs. J Vasc Interv Radiol 7:507–512

    Article  PubMed  CAS  Google Scholar 

  11. Vesely TM, Williams D, Weiss M et al (1999) Comparison of the AngioJet rheolytic catheter to surgical thrombectomy for the treatment of thrombosed hemodialysis grafts. Peripheral AngioJet Clinical Trial. J Vasc Interv Radiol 10:1195–1205

    Article  PubMed  CAS  Google Scholar 

  12. Schuman E, Quinn S, Standage B, Gross G (1994) Thrombolysis versus thrombectomy for occluded hemodyalisis grafts. Am J Surg 167:473–476

    Article  PubMed  CAS  Google Scholar 

  13. Dougherty MJ, Calligaro KD, Schindler N et al (1999) Endovascular versus surgical treatment for thrombosed hemodialysis grafts: a prospective, randomized study. J Vasc Surg 30:1016–1023

    Article  PubMed  CAS  Google Scholar 

  14. Bent CL, Sahni VA, Matson MB (2011) The radiological management of the thrombosed arteriovenous dialysis fistula. Clin Radiol 66:1–12

    Article  PubMed  CAS  Google Scholar 

  15. Haskal ZJ, Trerotola S, Dolmatch B et al (2010) Stent graft versus balloon angioplasty for failing dialysis-access grafts. N Engl J Med 362:494–503

    Article  PubMed  CAS  Google Scholar 

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Regional Vascular and Endovascular Unit, Central Manchester University Hospital Foundation Trust, Oxford Road, Manchester, M13 9WL, UK

    G. Kuhan & G. A. Antoniou

  2. Department of Renal Medicine, Central Manchester University Hospital Foundation Trust, Oxford Road, Manchester, M13 9WL, UK

    M. Nikam & S. Mitra

  3. Department of Radiology, Central Manchester University Hospital Foundation Trust, Oxford Road, Manchester, M13 9WL, UK

    F. Farquharson & N. Chalmers

  4. University of Aberdeen, Aberdeen, UK

    J. Brittenden

Authors
  1. G. Kuhan
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  2. G. A. Antoniou
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  3. M. Nikam
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  4. S. Mitra
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  5. F. Farquharson
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  6. J. Brittenden
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  7. N. Chalmers
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Correspondence to G. Kuhan.

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Kuhan, G., Antoniou, G.A., Nikam, M. et al. A Meta-analysis of Randomized Trials Comparing Surgery versus Endovascular Therapy for Thrombosed Arteriovenous Fistulas and Grafts in Hemodialysis. Cardiovasc Intervent Radiol 36, 699–705 (2013). https://doi.org/10.1007/s00270-013-0564-8

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  • DOI: https://doi.org/10.1007/s00270-013-0564-8

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