Radiocephalic wrist arteriovenous fistula for hemodialysis: Meta-analysis indicates a high primary failure rate

Objective. To improve the precision of the estimates of primary failure rates and primary and secondary 1 year patency of radial-cephalic arteriovenous fistulas (RCAVF) for hemodialysis. Design. Meta-analysis. Materials and methods. A Medline search was performed of the English language medical literature between January 1970 and October 2002. Key words that were searched included radiocephalic fistula, arteriovenous shunt, Brescia-Cimino fistula and patency. Primary failure, primary and secondary patency rates were analysed using the standard mixed effects model, which allows for variability between the different studies. Results. Eight prospective and 30 retrospective studies were included. The analysis showed a pooled estimated primary failure rate of 15.3% (95% CI: 12.7-18.3%). In addition, the pooled estimated primary and secondary patency rates of 62.5% (95% CI: 54.0-70.3%) and 66.0% (95% CI: 58.2-73.0%), respectively, were calculated. Subgroup analysis concerning various study characteristics, including study year, gender and age, did not reveal statistically significant differences. Conclusion. Although, the autogenous RCAVF is considered to be the primary choice for vascular access, this meta-analysis indicates a high primary failure rate and only moderate patency rates at 1 year of follow-up.

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