Preemptive Open Surgical vs. Endovascular Repair for Juxta-Anastomotic Stenoses of Autogenous AV Fistulae: A Meta-Analysis

Abstract

Purpose

There is controversy about the best mode of preemptive repair of juxta-anastomotic stenoses in radial-cephalic arteriovenous fistula (AVFs). The aim of the present review was to compare the outcome of surgical vs. endovascular repair of those AVF stenoses.

Methods

A systematic review and meta-analysis was performed for studies comparing the outcome of open surgical vs. endovascular preemptive repair of AVF stenoses located in the juxta-anastomotic region. A search was carried out in April 2015. The analyzed outcome measures were the primary patency at 12 and 18 months and the assisted primary patency at 24 months. In addition, assessment of the methodological quality of the included studies was carried out.

Results

Four non-randomized cohort studies (297 patients) were analyzed. A random effects model was used to pool the data. The pooled odds ratio (OR and 95% confidence intervals) for the primary patency at 12 and at 18 months was 0.42 (0.25-0.72) and 0.33 (0.2-0.56), respectively, showing statistically significant higher patency of the surgically repaired group. The pooled OR for the assisted primary patency at 24 months was 0.53 (0.28-0.98) also in favor of the surgically repaired group (p<0.04)

Conclusions

The available evidence, based on non-randomized cohort studies, suggests that surgery is the best way to treat ‘juxta-anastomotic’ stenotic lesions in distal radial-cephalic AVFs, although angioplasty remains a valuable but less durable option in this location of the stenosis.

Keywords

Angioplasty Arteriovenous fistula Juxta-anastomotic stenosis Meta-analysis Neoanastomosis Surgery

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References

Berman

Gentile

Impact of secondary procedures in autogenous arteriovenous fistula maturation and maintenance.

J Vasc Surg 2001;34(5):866–871

Mickley

Stenosis and thrombosis in haemodialysis fistulae and grafts: the surgeon's point of view.

Nephrol Dial Transplant 2004;19(2):309–311

Lazarides

Georgiadis

Argyriou

Safety issues in surgical and endovascular techniques to rescue failing or failed arteriovenous fistulas and arteriovenous grafts.

Contrib Nephrol 2015;184:153–163

Tordoir

Bode

Peppelenbosch

van der Sande

de Haan

Surgical or endovascular repair of thrombosed dialysis vascular access: is there any evidence?

J Vasc Surg 2009;50(4):953–956

Liberati

Altman

Tetzlaff

et al.

The PRISMA statement for reporting systematic reviews and meta-analysis that evaluate healthcare interventions: explanation and elaboration.

J Clin Epidemiol 2009;62(10):1–32

The Newcastle–Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses.

Available from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm Accessed April 2015.

Tessitore

Mansueto

Lipari

et al.

Endovascular versus surgical preemptive repair of forearm arteriovenous fistula juxta-anastomotic stenosis: analysis of data collected prospectively from 1999 to 2004.

Clin J Am Soc Nephrol 2006;1(3):448–454

Napoli

Prudenzano

Russo

Antonaci

Aprile

Buongiorno

Juxta-anastomotic stenosis of native arteriovenous fistulas: surgical treatment versus percutaneous transluminal angioplasty.

J Vasc Access 2010 11(4):346–351

Long

Brichart

Lermusiaux

et al.

Management of perianastomotic stenosis of direct wrist autogenous radial-cephalic arteriovenous accesses for dialysis.

J Vasc Surg 2011;53(1):108–114

10.

Kwon

Choi

et al.

Comparison of surgical and endovascular salvage procedures for juxta-anastomotic stenosis in autogenous wrist radiocephalic arteriovenous fistula.

Ann Vasc Surg 2014;28(8):1840–1846

11.

Rooijens

Tordoir

Stijnen

Burgmans

Smet de

Radiocephalic wrist arteriovenous fistula for hemodialysis: meta-analysis indicates a high primary failure rate.

Eur J Vasc Endovasc Surg 2004;28(6):583–589

12.

Bountouris

Kristmundsson

Dias

Zdanowski

Malina

Is repeat PTA of a failing hemodialysis fistula durable?

Int J Vasc Med 2014;2014:369687

13.

Kim

Kwon

Cho

Moon

Outcomes of salvage procedures for occluded autogenous radiocephalic arteriovenous fistula.

Ther Apher Dial 2011;15(5):448–453

14.

DOQI NKF. Clinical practice guidelines and clinical practice recommendations for 2006 updates: hemodialysis adequacy, peritoneal dialysis adequacy and vascular access.

Am J Kidney Dis 2006;48Suppl. 1S1–S322

15.

Chang

Hsu

et al.

Highly increased cell proliferation activity in the restenotic hemodialysis vascular access after percutaneous transluminal angioplasty: implication in prevention of restenosis.

Am J Kidney Dis 2004;43(1):74–84

16.

Lipari

Tessitore

Poli

et al.

Outcomes of surgical revision of stenosed and thrombosed forearm arteriovenous fistulae for haemodialysis.

Nephrol Dial Transplant 2007;22(9):2605–2612

17.

Mallik

Sivaprakasam

Pettigrew

Callaghan

Operative salvage of radiocephalic arteriovenous fistulas by formation of a proximal neoanastomosis.

J Vasc Surg 2011;54(1):168–173

18.

Manninen

Kaukanen

Ikäheimo

et al.

Brachial arterial access: endovascular treatment of failing Brescia-Cimino hemodialysis fistulas—initial success and long-term results.

Radiology 2001;218(3):711–718

19.

Asif

Lenz

Merrill

et al.

Percutaneous management of perianastomotic stenosis in arteriovenous fistulae: results of a prospective study.

Kidney Int 2006;69(10):1904–1909

20.

Cohen

Korzets

Neyman

et al.

Endovascular interventions of juxtaanastomotic stenoses and thromboses of hemodialysis arteriovenous fistulas.

J Vasc Interv Radiol 2009;20(1):66–70

21.

Swinnen

Lean Tan

Allen

Burgess

Mohan IV

Juxta-anastomotic stenting with aggressive angioplasty will salvage the native radiocephalic fistula for dialysis.

J Vasc Surg 2015;61(2):436–442

22.

Turmel-Rodrigues

Stenosis and thrombosis in haemodialysis fistulae and grafts: the radiologist's point of view.

Nephrol Dial Transplant 2004;19(2):306–308