Patency of autogenous and polytetrafluoroethylene upper extremity arteriovenous hemodialysis accesses: a systematic review.
OBJECTIVE
Patency rates for autogenous accesses are presumed to be better than for polytetrafluoroethylene (PTFE) accesses, although the strength of the supporting evidence is limited. We undertook this study to test the hypothesis that patency rates for upper extremity autogenous hemodialysis arteriovenous accesses in adults are superior to those for PTFE counterparts.


METHODS
A systematic review of relevant literature and meta-analysis of the patency data were performed. Studies were considered acceptable if patency data were reported by either life table or Kaplan-Meier method, including number of patients at risk.


RESULTS
The thirty-four studies that satisfied the inclusion criteria were composed predominantly of case series or nonrandomized controlled studies; no randomized, controlled studies comparing autogenous and PTFE accesses were included. The primary patency rate for autogenous accesses was 72% (95% confidence interval [CI], 70%-74%) at 6 months and 51% (95% CI, 48%-53%) at 18 months, and the corresponding primary patency rate for PTFE accesses was 58% (95% CI, 56%-61%) and 33% (95% CI, 31%-36%), respectively. The secondary patency rate for autogenous accesses was 86% (95% CI, 84%-88%) at 6 months and 77% (95% CI, 74%-79%) at 18 months, and the corresponding secondary patency rate for PTFE accesses was 76% (95% CI, 73%-79%) and 55% (95% CI, 51%-59%), respectively.


CONCLUSIONS
The patency rate for autogenous upper extremity arteriovenous hemodialysis accesses in adults is superior to that for PTFE counterparts, although the overall quality of the studies in the meta-analysis was less than ideal. Randomized, controlled studies to further examine the differences in outcome between these two access types are necessary.
Huber
Thomas S
TS
Department of Surgery, University of Florida College of Medicien, Gainesville, 32610-0286, USA. Huber@surgery.ufl.edu
Carter
Jeffrey W
JW
Carter
Randy L
RL
Seeger
James M
JM
D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects* / Q000379:methods; D001672:Biocompatible Materials / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006083:Graft Occlusion, Vascular / Q000209:etiology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D011138:Polytetrafluoroethylene / Q000009:adverse effects*; D006435:Renal Dialysis / Q000379:methods; D014182:Transplantation, Autologous / Q000009:adverse effects*; D034941:Upper Extremity; D014654:Vascular Patency / Q000502:physiology*
D001672:Biocompatible Materials; D011138:Polytetrafluoroethylene