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Abstract: TH-PO269

A Comparison Between the Efficacy and Safety of Endovascular Arteriovenous Fistula Creation and Surgically Created Fistulas: A Systematic Review and Meta-Analysis

Session Information

Category: Dialysis

  • 703 Dialysis: Vascular Access


  • Shimamura, Yoshinosuke, Teine Keijinkai Byoin, Sapporo, Japan

Group or Team Name

  • Scientific Review WorkshopS Peer Support Group (SRWS-PSG)

Endovascular arteriovenous fistula (eAVF) is a novel strategy for hemodialysis vascular access. We aimed to determine whether eAVF had better clinical efficacy and safety than surgical AVF (sAVF) in patients with chronic kidney disease (CKD).


In May 2021, we searched Cochrane CENTRAL, MEDLINE, EMBASE, Clinical, and the WHO International Clinical Trials Registry Platform for systematic reviews and meta-analyses of randomized controlled trials and observational studies that had assessed the efficacy and safety outcomes of eAVF compared with sAVF in patients with CKD requiring AVF creation. Pairs of two authors independently and in duplicate extracted data, assessed the risk of bias, and rated certainty of evidence. Using random-effects models, pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for binary outcomes, and median differences (MDs) with 95% CIs were calculated for continuous outcomes. Heterogeneity and certainty of evidence were assessed using the Grading of Recommendation, Assessment, Development, and Evaluation approach.


In seven studies (860 patients), ORs (95% CIs) for fistula maturation, procedural technical success, and all adverse events were 0.58 (0.05–6.91), 0.69 (0.04–11.98), and 6.31 (0.64–62.22), respectively. eAVF incurred less medical expenditure than sAVF (MD, USD $12,760; 95% CI -197,100 to -58,200). No studies reported patient satisfaction. The certainty of evidence was very low in most outcomes.


eAVF use in routine clinical practice for patients with CKD is limited. Multicenter randomized controlled trials are needed to confirm the efficacy and safety of eAVFs in selected populations.

Preferred Reporting Items for Systematic reviews and Meta-Analyses flow diagram

Forest plot for the primary outcome