What question did this study set out to answer?

To compare the outcomes of arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) in haemodialysis.

April 3, 2026BJS Open0 citationsOpen Access

Comparative outcomes of arteriovenous fistulas and grafts in haemodialysis: meta-analysis with subgroup analysis by fistula type and transposition status

CYChiehlun YangNanjing Brain Hospital WYWenhsing YangNew York City College of Technology LXLeijuan XiaoNanjing Brain Hospital

Key Points

To compare the outcomes of arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) in haemodialysis.
Systematic review of studies comparing AVF and AVG efficacy in adults
Meta-analyses pooled odds ratios for 1-year outcomes
Subgroup analysis by AVF site and transposition
Meta-regression assessed the impact of age, diabetes, and hypertension
Quality assessment using NIH tool for observational studies and RoB 2 for randomized trials
AVFs showed superior primary, primary-assisted, and secondary patency compared to AVGs
AVF associated with lower overall complications and mortality
Transposed AVFs had significantly better outcomes in primary-assisted patency and lower complications
Upper-arm AVFs improved primary patency, while basilic AVF enhanced secondary patency
Diabetes was found to modify outcomes positively for secondary patency and revisions

Abstract

Abstract Background Arteriovenous fistulas (AVFs) are preferred over arteriovenous grafts (AVGs) for haemodialysis, but effectiveness may vary by fistula subtype, access site, and transposition. Methods In this systematic review, PubMed, Web of Science, Scopus, and CENTRAL were searched up to 11 January 2025 for comparative studies of AVF versus AVG in adults. Random-effects meta-analyses pooled odds ratios (ORs) with 95% confidence intervals, standardized to 1-year outcomes (2-year effects summarized secondarily). Prespecified subgroups were AVF site (forearm versus upper arm), AVG site (forearm, upper arm, lower limb), AVF type (radiocephalic, brachiocephalic, brachiobasilic, basilic, brachial–brachial), and transposition. Observational studies were appraised with the National Institute of Health tool; randomized clinical trials with RoB 2. Meta-regression evaluated age, diabetes, and hypertension; certainty was appraised with GRADE. Results Sixty-three studies (357 333 patients: 226 078 AVF; 131 255 AVG) were included. At 1 year, AVF was associated with higher primary (OR = 1.61, 95% confidence interval 1.19 to 2.18), primary-assisted (OR = 1.69, 1.46 to 1.96), and secondary patency (OR = 1.69, 1.18 to 2.44), and lower overall complications (OR = 0.52, 0.34 to 0.78) and mortality (OR = 0.57, 0.34 to 0.98) versus AVG; primary failure and revision did not differ. Benefits were marked for transposed AVFs (primary-assisted OR = 2.07, 1.45 to 2.95; complications OR = 0.62, 0.43 to 0.88) and for upper-arm AVFs in primary patency (OR = 1.56, 1.05 to 2.31). Basilic AVF improved secondary patency (OR = 2.31, 1.17 to 4.57). Infection and thrombosis risks were lower for basilic and brachiobasilic AVF and upper-arm AVF. Meta-regression suggested diabetes modified effects (better secondary patency; fewer revisions), whereas age and hypertension did not. Certainty was generally low to moderate. Conclusion When standardized at 1 year, AVFs outperform AVGs for patency, complications, and mortality, with magnitude varying by site, transposition, and fistula type. Findings support individualized access planning and the role of transposed upper-arm AVFs when feasible. Registration number CRD420251125422 (https://www.crd.york.ac.uk/PROSPERO/home).

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