title: A meta-analysis of randomized trials comparing surgery versus endovascular therapy for thrombosed arteriovenous fistulas and grafts in hemodialysis.
abstract: OBJECTIVE
  To carry out a systematic review of randomized trials comparing surgery vs. endovascular therapy for occluded fistulas and grafts.
  
  
  METHODS
  All randomized trials which compared surgery and endovascular therapy for occluded fistulas and grafts were retrieved from 1990 onwards. The following search terms were used: "haemodialysis," "thrombosis," "arteriovenous fistula," "arteriovenous shunt," "end stage renal failure" on Medline and PubMed. The results of the pooled data were analysed by a fixed-effect model.
  
  
  RESULTS
  There were no randomized trials comparing surgery vs. endovascular therapy for native fistulas and vein grafts. Six randomized studies reporting on 573 occluded grafts were identified. Technical success, need for access line and primary patency at 30 days were similar between the two groups (odds ratio [OR] 1.40, 95 % confidence interval [CI] 0.91-2.14; OR 0.77, 95 % CI 0.44-1.34; and OR 1.15, 95 % CI 0.79-1.68, respectively). There was no significant difference in morbidity at 30 days between groups (OR 1.12, 95 % CI 0.67-1.86). There were no statistical difference between the two groups for 1 year primary patency (OR 2.08, 95 % CI 0.97-4.45). Primary assisted patency at 1 year was better with surgery (OR 3.03, 95 % CI 1.12-8.18) in a single study.
  
  
  CONCLUSIONS
  Comparable results to surgery have been achieved with endovascular techniques for occluded prosthetic grafts for dialysis access. Long-term data comparing the two groups were lacking. Further trials designed to encompass variation in methods are warranted in order to obtain the best available evidence particularly for native fistulas.
authors: Regional Vascular and Endovascular Unit, Central Manchester University Hospital Foundation Trust, Oxford Road, Manchester, M13 9WL, UK. gkuhan@nhs.net
authors: G
authors: G
authors: Kuhan
authors: G A
authors: GA
authors: Antoniou
authors: M
authors: M
authors: Nikam
authors: S
authors: S
authors: Mitra
authors: F
authors: F
authors: Farquharson
authors: J
authors: J
authors: Brittenden
authors: N
authors: N
authors: Chalmers
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D057510:Endovascular Procedures; D006083:Graft Occlusion, Vascular / Q000601:surgery*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis; D013927:Thrombosis / Q000601:surgery*; D014654:Vascular Patency