A systematic review and meta-analysis of surgical versus endovascular thrombectomy of thrombosed arteriovenous grafts in hemodialysis patients
Journal of Vascular Surgery, ISSN: 0741-5214, Vol: 69, Issue: 6, Page: 1976-1988.e7
2019
- 17Citations
- 61Captures
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Example: if you select the 1-year option for an article published in 2019 and a metric category shows 90%, that means that the article or review is performing better than 90% of the other articles/reviews published in that journal in 2019. If you select the 3-year option for the same article published in 2019 and the metric category shows 90%, that means that the article or review is performing better than 90% of the other articles/reviews published in that journal in 2019, 2018 and 2017.
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Metrics Details
- Citations17
- Citation Indexes17
- 17
- CrossRef3
- Captures61
- Readers61
- 61
Review Description
The major pitfall of arteriovenous grafts (AVGs) for hemodialysis patients is thrombosis and occlusion. Prompt intervention with either surgical or endovascular therapy to salvage the vascular access is crucial in maintaining effective hemodialysis. The purpose of this systematic review and meta-analysis was to assess and compare the efficacy of open surgical vs wholly endovascular therapy for the treatment of thrombosed AVGs. This review was conducted according to the PRISMA guidelines. Relative risks **(RRs) and pooled proportions for both primary and secondary outcomes were calculated. A total of eight randomized, controlled trials and two retrospective cohort studies were included, comprising 806 (63%) and 466 (37%) participants in the surgical and wholly endovascular treatment arms respectively. There were no significant differences between endovascular and surgical therapy in the 30-, 60-, and 90-day primary nonpatency rates. However, endovascular therapy reported a significantly higher 1-year primary nonpatency rate (rate ratio [RR], 1.22; 95% confidence interval [CI], 1.13-1.33; P <.01) and the 2-year primary nonpatency rate (RR, 1.26; 95% CI, 1.10-1.45; P <.01) as compared with surgical therapy. Similarly, the endovascular arm had a higher pooled proportion of primary nonpatency of 87.7% (95% CI, 81.5%-92.9%; P =.297), as compared with the surgical arm (72.1%; 95% CI, 66.4%-77.4%; P =.289). In terms of secondary nonpatency rates, there were no significant differences between endovascular and surgical procedures at 30, 60, and 90 days. Endovascular procedures reported a significantly higher technical failure rate as compared with surgical thrombectomy (RR, 1.58; 95% CI, 1.06-2.37; P =.03). There was no significant difference in terms of minor and major complications. Our data suggest that, for thrombectomy of AVGs, wholly endovascular therapy seems to be inferior to open surgery plus adjuncts based on the long-term patency and technical failure rates. However, further research in the form of a well-conducted randomized trial is warranted to establish a firmer conclusion.
Bibliographic Details
http://www.sciencedirect.com/science/article/pii/S0741521418325643; http://dx.doi.org/10.1016/j.jvs.2018.10.102; http://www.scopus.com/inward/record.url?partnerID=HzOxMe3b&scp=85065843615&origin=inward; http://www.ncbi.nlm.nih.gov/pubmed/31159991; https://linkinghub.elsevier.com/retrieve/pii/S0741521418325643; https://dx.doi.org/10.1016/j.jvs.2018.10.102
Elsevier BV
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