Stent graft placement versus angioplasty for hemodialysis access failure: a meta-analysis.

Background: Hemodialysis is a common treatment for end-stage renal disease, and maintenance of access patency remains a key issue. Angioplasty is recommended as the first choice for access stenosis, but it poses a risk of a high rate of restenosis. Stent graft placement can generate a high patency rate of dialysis access. This study aimed to compare the primary patency of the treatment area and access circuit between stent grafts and angioplasty in dialysis access failure.

Materials And Methods: Three electronic databases, namely, PubMed, Cochrane Library of Systematic Reviews, and EMBASE, were searched from the database inception to September 2017 without language restriction. Randomized controlled trials comparing the primary patency of the treatment area and access circuit between stent graft and angioplasty were included. Two independent reviewers assessed the quality of the trials and extracted relevant data.

Results: Four trials satisfied our inclusion criteria. Our pooled results suggested that stent graft placement was associated with significantly higher primary patency of treatment area (hazard ratio: 0.65, 95% confidence interval: 0.55-0.77, P < 0.0001, I = 0) and access circuit (hazard ratio: 0.76, 95% confidence interval: 0.65-0.88, P = 0.0004, I = 0) in hemodialysis access compared with those of standard angioplasty.

Conclusions: The patency of hemodialysis access may be higher after stent graft placement combined with standard angioplasty than after angioplasty alone.