Comparing Outcomes Of Upper Extremity Brachiobasilic Arteriovenous Fistulas And Prosthetic Arteriovenous Grafts: A Systematic Review And Meta-analysis
David Haddad, BS1, Venkata Sai Jasty, BS1, Chiu-Hsieh (Paul) Hsu, PhD2, Scott Berman, MD1, Wei Zhou, MD1, Tze-Woei Tan, MD1.
1University of Arizona College of Medicine - Tucson, Tucson, AZ, USA, 2University of Arizona College of Public Health, Tucson, AZ, USA.
OBJECTIVES: It is unclear what is the optimal upper extremity hemodialysis access option for patients without suitable cephalic vein. The objective of this systematic review and meta-analysis was to examine the outcomes for upper arm brachiobasilic arteriovenous fistulas (BBAVF) and prosthetic arteriovenous grafts (AVG).
METHODS: A systemic review was performed by 2 independent investigators to identify all English publications that compared the outcomes of BBAVFs and AVGs (1994-2019). One and 2-year primary and secondary patency rates were analyzed using the Comprehensive Meta-Analysis program. The random-effects model was used to pool effect sizes of individual studies and the Higgins I2 statistic to asses between-study variability.
RESULTS: Twenty-three studies examining 3,949 patients were identified from a search of 2,157 articles to have met the inclusion criteria. Two of these studies were randomized control trials, 2 prospective studies, 1 controlled-comparative study, and 18 retrospective studies. There was marked heterogenicity in the study design and reporting of results. The number of studies evaluated for each designated outcome at 1 and 2-year time intervals, respectively, were 23 and 16 studies for primary patency and 17 and 14 studies for secondary patency. The 1-year primary patency rates (pooled odd’s ratio (OR) = 1.8, 95% CI 1.3-2.5, p = 0.001, I2 = 79.6%) (Figure 1.) and 2-year primary patency rates (OR = 2.5, 95% CI 1.6-3.9, p < 0.001, I2 = 84.8%) were significantly better for BBAVFs than AVGs. Compared to AVGs, 1-year secondary patency (OR = 1.4, 95% CI 1.1-1.9, p = 0.018, I2 = 56.0%), and 2-year secondary patency (OR = 1.7, 95% CI 1.3-2.3, p < 0.001, I2 = 53.6%) were also significantly higher for BBAVFs.
CONCLUSIONS: The outcomes for BBAVFs appear to be consistently superior to upper extremity prosthetic hemodialysis access. This analysis supports the preferential placement of BBAVFs over AVGs in patients with a suitable upper arm basilic vein. 
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