Tapered Graft And Non-tapered Graft In Upper Extremity Prosthetic Dialysis Access: A Systematic Review And Meta-analysis
Venkata Sai J. Jasty, B.S.1, David Haddad, B.S.1, Chiu-Hsieh (Paul) Hsu, PhD2, Wei Zhou, M.D.1, Jeffrey Siracuse, M.D.3, Tze-Woei Tan, M.D.1.
1University of Arizona College of Medicine - Tucson, Tucson, AZ, USA, 2University of Arizona College of Public Health, Tucson, AZ, USA, 3Boston University School of Medicine, Boston, MA, USA.
OBJECTIVES: It is unclear whether tapered arteriovenous grafts (AVGs) are superior to non-tapered AVGs when it comes to preventing upper extremity ischemic steal syndrome. We aimed to evaluate the effectiveness of tapered and non-tapered AVGs using systematic review and meta-analysis.
METHODS: A literature search was systemically performed by two independent investigators to identify all English publications from 1999 to 2019 that directly compared the outcomes of upper extremity tapered and non-tapered AVGs. The Comprehensive Meta-analysis program was utilized to evaluate primary patency at 1-year (number of studies (n)=4), secondary patency at 1-year (n=3), and risk of ischemic steal (n=5) and infection (n=4). Effect sizes of individual studies were pooled using random-effects model, and between-study variability was assessed using the Higgins I2 statistic.
RESULTS: Of 5,808 studies screened, five studies involving 4,397 patients have met the inclusion criteria and included in the analysis. Meta-analyses revealed no significant difference for the primary patency (pooled odds ratio (OR) 1.33, 95% Confidence Incidence (CI) 0.93-1.90, p=.122, I2=10%) and secondary patency both at 1-year (OR 1.49, 95% CI 0.84-2.63, p=.173, I2=13%) between the tapered and non-tapered upper extremity AVG. The risks of ischemic steal (OR 0.92, 95% CI 0.23-2.01, p=.885, I2=48%) and infection (OR 0.62, 95% CI 0.23-1.23, p=.189, I2=29%) were similar between tapered and non-tapered AVGs.
CONCLUSIONS: The patency rate and risk of ischemic steal syndrome are comparable for upper extremity tapered and non-tapered AVGs. This meta-analysis does not support the routine use of tapered graft over the non-tapered graft to prevent ischemic steal syndrome in upper extremity dialysis access. 
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