Abstract

Endovascular AVG venous anastomosis improves cumulative patency compared to traditional sutured anastomosis: a meta-analysis

Author(s): Brad C. Astor, KMLST Moorthi, Lisa Grant and Terry Litchfield

Objective: Arteriovenous graft (AVG) patency outcomes continue to be plagued by venous anastomotic stenosis, which can lead to eventual thrombosis and AVG abandonment. Venous stenosis occurs most commonly at the graft-vein and juxta-anastomotic vein segments. A recent publication of a novel endovascular AVG anastomosis (EndoForce) showed excellent outcomes with a cumulative patency of 92% for AVGs. The purpose of this investigation was to compare the outcomes of the EndoForce endovascular venous anastomotic connector to traditional sutured anastomosis AVGs via meta-analysis.

Methods: A meta-analysis was conducted to estimate the 6-month patency of AVGs implanted using traditional surgical techniques. We compared those estimates to the results achieved with the EndoForce venous anastomotic device.

Results: A total of 31 studies, with 45 distinct arms, provided data on 6-month cumulative patency. The random-effects pooled estimate of 6-month cumulative patency was 83.23% (95% confidence interval [CI]: 80.18, 86.28). A total of 32 studies, including 46 arms, provided data on primary patency. The pooled estimate for 6-month primary patency was 60.35% (95% CI: 56.21, 64.49). The novel device achieved better 6-month cumulative patency (92.08%; 95% CI: 86.98-97.18) than the pooled estimate (p<0.001) and similar primary patency (60.21% [95% CI: 50.84, 69.59]; p=0.75).

Conclusion: This study provides direct evidence that the EndoForce venous anastomotic device improves 6-month cumulative patency compared to traditional sutured AVG venous anastomosis.