title: The outcome of the proximal radial artery arteriovenous fistula.
abstract: BACKGROUND
  Guidelines recommend placing native arteriovenous fistulas (AVFs) as far distally in the upper extremity as possible. If there are adequate veins and adequate arteries, a wrist fistula, which offers notably lower risks than grafts and catheters, would be the first choice for long-term hemodialysis. With increasing failure and difficulty to create wrist fistulas, we reviewed outcomes of the proximal radial AVF (PRAAVF) and demonstrate that it is an effective technique.
  
  
  METHODS
  A systemic literature research was conducted in PubMed and related bibliographies. The focus of data extraction was primary failure, primary patency rates, and secondary patency rates after 1 and 2 years. Estimates were pooled with the random effects model, and meta-regression and sensitivity analysis were performed to explore heterogeneity.
  
  
  RESULTS
  According to selection criteria formulated a priori, 10 articles (n = 1310) were included and finally analyzed after screening 1687 articles. The pooled primary failure was 12.3% (95% confidence interval [CI], 7.6%-17.0%; χ(2) = 70.8, I(2) = 87.3%), the primary patency, including primary failure, was 73.6% (95% CI, 52.4%-94.9%; χ(2) = 71.3, I(2) = 97.2%) at 1 year and 70.5% (95% CI, 50.6%-90.5%; χ(2) = 58.8, I(2) = 96.6%) at 2 years. Secondary patency was 80.0% (95% CI, 72.8%-87.2%; χ(2) = 24.42, I(2) = 75.4%) at 1 year and 73.7% (95% CI, 65.2%-82.2%; χ(2) = 28.51, I(2) = 79.0%) at 2 years. Individual variate meta-regression analysis found the definition of primary failure was a significant source of heterogeneity (P = .009). Steal syndromes developed in four of 832 (0.5%) of the PRAAVFs, and venous hypertension developed in four of 284 (1.4%).
  
  
  CONCLUSIONS
  The PRAAVF presented low to moderate primary failure and high primary and secondary patency rates with acceptable complications. Consideration of the specific fistula is required when creating a vascular access, especially when a wrist fistula has failed or is predicted to be unsuccessful.
authors.affiliation: Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University; the Key Laboratory of Nephropathy, Zhejiang Province; and the Kidney Disease Immunology Laboratory, The Third Grade Laboratory, State Administration of Traditional Chinese Medicine of PR China, Hangzhou, China.
authors.forename: Cong Cong
authors.initials: CC
authors.lastname: Wu
authors.affiliation: Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University; the Key Laboratory of Nephropathy, Zhejiang Province; and the Kidney Disease Immunology Laboratory, The Third Grade Laboratory, State Administration of Traditional Chinese Medicine of PR China, Hangzhou, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Jiang
authors.affiliation: Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University; the Key Laboratory of Nephropathy, Zhejiang Province; and the Kidney Disease Immunology Laboratory, The Third Grade Laboratory, State Administration of Traditional Chinese Medicine of PR China, Hangzhou, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Cheng
authors.affiliation: Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University; the Key Laboratory of Nephropathy, Zhejiang Province; and the Kidney Disease Immunology Laboratory, The Third Grade Laboratory, State Administration of Traditional Chinese Medicine of PR China, Hangzhou, China.
authors.forename: Ling Fei
authors.initials: LF
authors.lastname: Zhao
authors.affiliation: Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University; the Key Laboratory of Nephropathy, Zhejiang Province; and the Kidney Disease Immunology Laboratory, The Third Grade Laboratory, State Administration of Traditional Chinese Medicine of PR China, Hangzhou, China.
authors.forename: Kai Xiang
authors.initials: KX
authors.lastname: Sheng
authors.affiliation: Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University; the Key Laboratory of Nephropathy, Zhejiang Province; and the Kidney Disease Immunology Laboratory, The Third Grade Laboratory, State Administration of Traditional Chinese Medicine of PR China, Hangzhou, China. Electronic address: chenjianghua@zju.edu.cn.
authors.forename: Jiang Hua
authors.initials: JH
authors.lastname: Chen
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods*; D016009:Chi-Square Distribution; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D017534:Radial Artery / Q000503:physiopathology / Q000601:surgery*; D006435:Renal Dialysis; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure; D014654:Vascular Patency; D014953:Wrist / Q000098:blood supply*