Autogenous arteriovenous fistula (AVF) is the vascular access of choice for chronic kidney disease to patients requiring hemodialysis. However, there still needs to be more consensus on whether the best surgical approach is an end-of-vein to side-of-artery (ETS) or a side-of-vein to side-of-artery (STS) anastomosis. This study aims to compare venous maturation rates, mid-term patency and post-operative steal syndrome rates between ETS and STS techniques for arteriovenous fistulas. Three databases were searched during November 2022: PubMed, Scopus, and ISI Web of Knowledge. Two independent reviewers examined both titles and abstracts. In all studies, eligibility was assessed, and data regarding the study's characteristics, methods, and considered outcomes was obtained. The odds ratio (OR) assessed maturation rates, 6 and 12-month patency, and steal syndrome. Meta-analysis was done using a fixed-effect model if I2 values were under 30%, and a random-effects model from 30 to 60%. Thirteen studies were included, with a total of 1960 patients studied. Patients undergoing ETS anastomosis had higher maturation rates (OR 3.30 95% CI 1.81, 6.00, I2=20%). No difference was found in patency at 6 months (OR 1.05 95% CI 0.69, 1.59, I2=54%) and 12 months (OR 0.75 95% CI 0.46, 1.23, I2=7%). Regarding steal syndrome, STS anastomosis presented a greater risk of developing this post-operative complication (OR 0.24 95% CI 0.11, 0.50, I2=0%). The present review suggests that ETS anastomosis is associated with higher maturation rates and a lower risk of arterial steal syndrome. Randomized clinical trials are required to confirm our findings.
Keywords: Arteriovenous Shunt; Chronic Kidney Failure; Hemodialysis; Surgical Anastomosis; Vascular Patency.
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