Bovine Carotid Artery Grafts versus PTFE grafts for hemodialysis access: a systematic review and meta-analysis

Arteriovenous grafts are considered for hemodialysis access in patients without a suitable vein for the creation of an arteriovenous fistula. The most commonly used synthetic polytetrafluorethylene (PTFE) graft carries a high risk of infection (6 to 29%) and limited biocompatibility. The bovine carotid artery graft (BCAG), a biological alternative, may address these limitations. This systemic review and meta-analysis compared clinical outcomes of BCAG versus PTFE grafts. MEDLINE, Embase and Cochrane Library were searched for eligible studies (PROSPERO, no. 607603). Studies including patients with BCAG access were included, those published before 2000 were excluded. If PTFE-outcomes were reported, they were pooled for comparison. The primary outcome was (graft) infection. Secondary outcomes included primary, primary assisted and secondary patency as well as postoperative complications. Meta-analyses and subgroup analyses used random-effects models. Eleven studies (one randomized controlled trial and ten cohort studies) involving 1247 patients met the inclusion criteria. Infection rates were similar between BCAG and PTFE (64 vs. 95 per 1000 patient years; p=0.43). At 12 months, BCAG showed significantly higher primary (47% vs. 29%; p=0.02) and primary assisted patency (66% vs. 34%; p=0.004). Secondary patency at 12 months was not significantly higher in the BCAG group (78% vs. 57%; p=0.10). No differences were observed in the incidence of postoperative complications. BCAG demonstrated superior primary and primary assisted patency compared to PTFE grafts in hemodialysis access. Other outcomes also favored BCAG, but lacked statistical significance. Large-scale randomized trials are warranted to further define the role of BCAG and support evidence-based decisions.