The Outcome Of The Proximal Radial Artery Arteriovenous Fistula

Objective:Guidelines recommend placing native arteriovenous fistulas as far distally in the upper extremity as possible; if there are adequate veins and adequate arteries, wrist fistula would be the first choice for long-term hemodialysis which offer notably lower risks than grafts and catheters. With increasing failure and difficulty to create wrist fistulas, we aim to review outcomes of the proximal radial artery arteriovenous fistula (PRAAVF) and demonstrate that it is an effective technique.Methods:A systemic literature research was conducted in Pubmed and related bibliographies. The focuses of data extraction were primary failure, primary patency rates and secondary patency rates after1and2years. Estimates were pooled with the random effects model and meta-regression and sensitivity analysis were performed to explore heterogeneity. Results:According to selection criteria formulated a priori,10articles (n=1310) were included and analyzed finally after screening1687records. The pooled primary failure was12.3%(95%CI7.6-17.0;χ2=70.8,12=87.3%),1-year primary patency rate including primary failure was73.6%(95%CI52.4-94.9;χ2=71.3,12=97.2%),2-year primary patency was70.5%(95%CI50.6-90.5;%2=58.8,12=96.6%),1-year secondary patency was80.0%(95%CI72.8-87.2; x2=24.42,12=75.4%),2-year secondary patency was73.7%(95%CI65.2-82.2;%2=28.51,12=79.0%). In individual variate meta-regression, the definition of primary failure was a significant source of heterogeneity (p=0.009).0.5%of the PRAAVF developed steal syndromes (4/832) and1.4%of the PRAAVF developed venous hypertension (4/284).Conclusion:The PRAAVF presented low to moderate primary failure and high primary and secondary patency rate with acceptable complications. Consideration of the specific fistula is required when creating a vascular access, especially when a wrist fistula failed or was predicted to be unsuccessful.