title: Preemptive open surgical vs. endovascular repair for juxta-anastomotic stenoses of autogenous AV fistulae: a meta-analysis.
abstract: OBJECTIVE
  There is controversy about the best mode of preemptive repair of juxta-anastomotic stenoses in radial-cephalic arteriovenous fistula (AVFs). The aim of the present review was to compare the outcome of surgical vs. endovascular repair of those AVF stenoses.
  
  
  METHODS
  A systematic review and meta-analysis was performed for studies comparing the outcome of open surgical vs. endovascular preemptive repair of AVF stenoses located in the juxta-anastomotic region. A search was carried out in April 2015. The analyzed outcome measures were the primary patency at 12 and 18 months and the assisted primary patency at 24 months. In addition, assessment of the methodological quality of the included studies was carried out.
  
  
  RESULTS
  Four non-randomized cohort studies (297 patients) were analyzed. A random effects model was used to pool the data. The pooled odds ratio (OR and 95% confidence intervals) for the primary patency at 12 and at 18 months was 0.42 (0.25-0.72) and 0.33 (0.2-0.56), respectively, showing statistically significant higher patency of the surgically repaired group. The pooled OR for the assisted primary patency at 24 months was 0.53 (0.28-0.98) also in favor of the surgically repaired group (p&lt;0.04).
  
  
  CONCLUSIONS
  The available evidence, based on non-randomized cohort studies, suggests that surgery is the best way to treat 'juxta-anastomotic' stenotic lesions in distal radial-cephalic AVFs, although angioplasty remains a valuable but less durable option in this location of the stenosis.
authors.affiliation: Department of Vascular Surgery, Democritus University Hospital, Alexandroupolis - Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Argyriou
authors.affiliation: Department of Vascular Surgery, Democritus University Hospital, Alexandroupolis - Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Schoretsanitis
authors.affiliation: Department of Vascular Surgery, Democritus University Hospital, Alexandroupolis - Greece.
authors.forename: Efstratios I
authors.initials: EI
authors.lastname: Georgakarakos
authors.affiliation: Department of Vascular Surgery, Democritus University Hospital, Alexandroupolis - Greece.
authors.forename: George S
authors.initials: GS
authors.lastname: Georgiadis
authors.affiliation: Department of Vascular Surgery, Democritus University Hospital, Alexandroupolis - Greece.
authors.forename: Miltos K
authors.initials: MK
authors.lastname: Lazarides
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D016121:Brachiocephalic Veins / Q000503:physiopathology / Q000601:surgery*; D016009:Chi-Square Distribution; D057510:Endovascular Procedures / Q000009:adverse effects; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D016017:Odds Ratio; D018579:Patient Selection; D017534:Radial Artery / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation; D012307:Risk Factors; D016896:Treatment Outcome; D014654:Vascular Patency