: Comparison of end-to-side and side-to-side anastomosis techniques in arteriovenous fistula for hemodialysis. A systematic review and meta-analysis

Abstract

Introduction: Autogenous arteriovenous fistula (AVF) is the vascular access of choice for chronic kidney disease to patients requiring hemodialysis. However, there is still a lack of consensus on whether the best surgical approach is an end-of-vein to side-of-artery (ETS) or a side-of-vein to side-of-artery (STS) anastomosis. The aim of this study is to compare venous maturation rates, mid-term patency and post-operative steal syndrome rates between ETS and STS techniques for arteriovenous fistulas. Methods: Three databases were searched during November 2022: PubMed, Scopus, and ISI Web of Knowledge. Both titles and abstracts were examined by two independent reviewers. In all studies eligibility was assessed and data regarding the studies characteristics, methods and considered outcomes was obtained. Odds ratio (OR) was used to evaluate maturation rates, patency at 6 and 12 months and steal syndrome. Meta-analysis was done using a fixed-effect model if I2 values were under 50%, and a random-effects model if not. Results: Thirteen studies were included, with a total of 1960 patients studied. Patients undergoing ETS anastomosis had higher maturation rates (OR 3.30 95% CI 1.81, 6.00, I2=20%). No difference was found in patency at six months (OR 1.05 95% CI 0.69, 1.59, I2=54%) and at twelve months (OR 0.75 95% CI 0.46, 1.23, I2=7%). Regarding steal syndrome, STS anastomosis presented with greater risk of developing this post-operative complication (OR 0.24 95% CI 0.11, 0.50, I2=0%). Conclusions: The present review suggests that (ETS) anastomosis is associated with higher maturation rates and lower risk of arterial steal syndrome. Larger studies are required to confirm our findings.