title: Early cannulation grafts for haemodialysis: a systematic review.
abstract: OBJECTIVE
  Arteriovenous grafts have advantages compared with central venous catheters for dialysis access and guidelines suggest their use as second choice after arteriovenous fistulas. Standard practice with expanded polytetrafluoroethylene (ePTFE) grafts has been to avoid cannulation for 2 weeks following placement, but new generation grafts have been marketed for their early cannulation properties allowing use as an alternative to central venous catheters for prompt access. The aim of this review is to search the current literature for evidence of early cannulation of new generation grafts and to assess their patency and complication rates.
  
  
  METHODS
  Electronic databases were searched for studies assessing the use of early cannulation grafts for dialysis in accordance with PRISMA. The primary outcomes for this study were primary patency rate, primary-assisted patency rate and secondary patency rate. Secondary outcomes were timing of first cannulation, rates of access thrombosis, steal syndrome, pseudo-aneurysm and infection.
  
  
  RESULTS
  Following strict inclusion/exclusion criteria by two reviewers, 15 studies were included in our review and divided into the different types of graft. Flixene, Avflo, Rapidax and Acuseal grafts showed that early cannulation within 72 h was possible; there was no evidence of the use of Vectra within 2 weeks of placement. All grafts showed similar patency and complication rates as previously published data on standard ePTFE grafts.
  
  
  CONCLUSIONS
  Our review showed that early cannulation is possible without detriment, but data did not allow specific graft recommendations. Therefore, we feel that a multicentre, randomised controlled trial is necessary to compare early cannulation grafts.
authors.affiliation: Department of Renal Surgery, University Hospital Birmingham, Birmingham - UK.|ReDVA Research Consortium, Dundee - UK.
authors.forename: Julien
authors.initials: J
authors.lastname: Al Shakarchi
authors.affiliation: ReDVA Research Consortium, Dundee - UK.|Medical Research Institute, University of Dundee, Dundee - UK.
authors.forename: Graeme
authors.initials: G
authors.lastname: Houston
authors.affiliation: Department of Renal Surgery, University Hospital Birmingham, Birmingham - UK.|ReDVA Research Consortium, Dundee - UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Inston
mesh_terms: D017541:Aneurysm, False / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000295:instrumentation*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D002404:Catheterization / Q000009:adverse effects; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000503:physiopathology / Q000628:therapy; D006435:Renal Dialysis; D012307:Risk Factors; D013927:Thrombosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D016896:Treatment Outcome; D014654:Vascular Patency