The outcome of the proximal radial artery arteriovenous fistula.

Abstract

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. 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. 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%). 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.