Tapered and non-tapered prosthetic grafts in upper extremity dialysis access: A systematic review and meta-analysis

2020 ◽  
pp. 112972982097417
Author(s):  
Venkata Sai Jasty ◽  
David Haddad ◽  
Babu Mohan ◽  
Wei Zhou ◽  
Jeffrey J Siracuse ◽  
...  
Keyword(s):  
Systematic Review ◽  
Upper Extremity ◽  
Meta Analysis ◽  
Primary Patency ◽  
Secondary Patency ◽  
Dialysis Access ◽  
Significant Difference ◽  
Arteriovenous Grafts ◽  
Meta Analyses ◽  
Steal Syndrome

Objective: It is unclear whether tapered arteriovenous grafts (AVGs) are superior to non-tapered AVGs when it comes to preventing upper extremity ischemic steal syndrome. We aimed to evaluate the outcomes of tapered and non-tapered AVGs using systematic review and meta-analysis. Methods: A literature search was systemically performed to identify all English publications from 1999 to 2019 that directly compared the outcomes of upper extremity tapered and non-tapered AVGs. Outcomes evaluated were the primary patency at 1-year (number of studies ( n) = 4), secondary patency at 1-year ( n = 3), and risk of ischemic steal ( n = 5) and infection ( n = 4). Effect sizes of individual studies were pooled using random-effects model, and between-study variability was assessed using the I2 statistic. Results: Of 5808 studies screened, five studies involving 4397 patients have met the inclusion criteria and included in the analysis. Meta-analyses revealed no significant difference for the risk of ischemic steal syndrome (pooled odds ratio (OR) 0.92, 95% Confidence Incidence (CI) 0.29–2.91, p = 0.89, I2 = 48%) between the tapered and non-tapered upper extremity AVG. The primary patency (OR 1.33, 95% CI 0.93–1.90, p = 0.12, I2 = 10%) and secondary patency at 1-year (OR 1.49, 95% CI 0.84–2.63, p = 0.17, I2 = 13%), and rate of infection (OR 0.62, 95% CI 0.30–1.27, p = 0.19, I2 = 29%) were also similar between the tapered and non-tapered AVG. Conclusions: The risk of ischemic steal syndrome and patency rate are comparable for upper extremity tapered and non-tapered AVGs. This meta-analysis does not support the routine use of tapered graft over non-tapered graft to prevent ischemic steal syndrome in upper extremity dialysis access. However, due to small number of studies and sample sizes as well as limited stratification of outcomes based on risk factors, future studies should take such limitations into account while designing more robust protocols to elucidate this issue.

Comparing Outcomes of Upper Extremity Brachiobasilic Arteriovenous Fistulas and Arteriovenous Grafts: A Systematic Review and Meta-Analysis

2020 ◽  
pp. 112972982097078
Author(s):  
David J. Haddad ◽  
Venkata Sai Jasty ◽  
Babu Mohan ◽  
Chiu-Hsieh Hsu ◽  
Chyi Chyi Chong ◽  
...  
Keyword(s):  
Systematic Review ◽  
Upper Extremity ◽  
Meta Analysis ◽  
Primary Patency ◽  
Secondary Patency ◽  
Random Effects Model ◽  
Hemodialysis Access ◽  
Basilic Vein ◽  
Arteriovenous Fistulas ◽  
Arteriovenous Grafts

Objective: It is unclear what the optimal upper extremity hemodialysis access is for patients without a suitable cephalic vein for arteriovenous fistulas (AVFs). The objective of this systematic review and meta-analysis was to compare the outcomes for upper extremity transposed brachiobasilic AVFs (BBAVFs) and prosthetic arteriovenous grafts (AVGs). Methods: A systematic review was performed to identify all English publications and abstracts comparing the patency outcomes of upper extremity BBAVFs and AVGs (January 1st, 1994 to April 1st, 2020). The outcomes assessed were 1-year and 2-year primary and secondary patency rates. Pooled odds ratios (OR) were calculated using the random-effects model, and I2 statistic was used to assess between-study variability. Results: Twenty-three studies examining 2799 patients were identified and included in the study. The 1-year primary patency rates (OR = 1.68, 95% CI 1.24–2.28, p = 0.001, I2 = 69.40%) and 2-year primary patency rates (OR = 2.33, 95% CI 1.59–3.43, p < 0.001, I2 = 68.26%) were significantly better for BBAVFs than AVGs. Compared to AVGs, the 1-year secondary patency rates (OR = 1.45, 95% CI 1.05–1.98, p = 0.022, I2 = 56.64%) and 2-year secondary patency rates (OR = 1.93, 95% CI 1.39–2.68, p < 0.001, I2 = 57.61%) were also significantly higher for BBAVFs. Conclusion: The outcomes for upper extremity BBAVFs appear to be consistently superior to prosthetic hemodialysis access. This analysis supports the preferential placement of BBAVFs over AVGs in patients with a suitable upper extremity basilic vein.

scholarly journals Covered stents versus balloon angioplasty for failure of arteriovenous access: a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e044356
Author(s):  
Benjamin Ng ◽  
Magnus Fugger ◽  
Igho Jovwoke Onakpoya ◽  
Andrew Macdonald ◽  
Carl Heneghan
Keyword(s):  
Systematic Review ◽  
Balloon Angioplasty ◽  
Meta Analysis ◽  
Primary Patency ◽  
Secondary Patency ◽  
Covered Stents ◽  
Significant Difference ◽  
Randomised Controlled ◽  
Meta Analyses ◽  
Stage Renal Disease

IntroductionPatients with end-stage renal disease may require arteriovenous (AV) access in the form of arteriovenous fistulae (AVFs) or arteriovenous grafts (AVGs) for haemodialysis. AV access dysfunction requires intervention such as plain balloon angioplasty or covered stents to regain patency.AimTo systematically review and meta-analyse the patency outcomes of covered stents in failing haemodialysis AV access, compared with balloon angioplasty.MethodsThe review was first registered on the International Prospective Register of Systematic Reviews (CRD42018069955) before data collection. We searched six electronic databases to identify relevant randomised controlled trials (RCTs) up until August 2020, without language restriction. Two reviewers assessed the suitability and quality of studies for inclusion using the Consolidated Standards of Reporting Trials guidelines. We meta-analysed data using a random-effects model.ResultsWe included seven studies including 1147 patients in the systematic review, of which 867 had AVGs and 280 had AVFs. One study was an ongoing RCT. In the meta-analyses, we assessed patients with failing AVGs only. Overall risk of bias was moderate. Covered stents were associated with lower loss of patency versus angioplasty alone at 6, 12 and 24 months (OR 4.48, 95% CI 1.98 to 10.14, p<0.001; OR 4.07, 95% CI 1.74 to 9.54, p=0.001; OR 2.24, 95% CI 1.17 to 4.29, p=0.01, respectively). Covered stents afforded superior access circuit primary patency compared with angioplasty alone at 6 and 12 months (OR 1.91, 95% CI 1.31 to 2.80, p<0.001; OR 1.97, 95% CI 1.14 to 3.41, p=0.02, respectively). This was not significant at 24 months. There was no significant difference in loss of secondary patency between groups at 12 or 24 months (OR 0.74, 95% CI 0.45 to 1.23, p=0.25; OR 0.67, 95% CI 0.29 to 0.154, p=0.34, respectively).ConclusionOur results support use of covered stents over angioplasty alone, at 6, 12 and 24 months in failing AVGs. Further clinical trials are warranted.

Impact of arteriovenous fistulas versus arteriovenous grafts on vascular access performance in haemodialysis patients: A systematic review and meta-analysis

Vascular ◽  
2021 ◽  
pp. 170853812110414
Author(s):  
Shahin Hajibandeh ◽  
Hannah Burton ◽  
Philippa Gleed ◽  
Shahab Hajibandeh ◽  
Teun Wilmink
Keyword(s):  
Failure Rate ◽  
Vascular Access ◽  
Meta Analysis ◽  
Primary Patency ◽  
Free Access ◽  
Secondary Patency ◽  
Confounding By Indication ◽  
Arteriovenous Fistulas ◽  
Significant Difference ◽  
Arteriovenous Grafts

Background Controversy exists regarding the best-performing vascular access type for patients undergoing haemodialysis. We aimed to compare outcomes of starting dialysis on arteriovenous fistulas (AVFs) versus arteriovenous grafts (AVGs) in haemodialysis patients. Methods We conducted a systematic search of multiple electronic information sources and bibliographic reference lists. The following outcome parameters were evaluated at 1, 2 and 5 years: primary failure, defined as access never used for dialysis; primary patency, defined as intervention-free access survival; primary-assisted patency, defined as uninterrupted access survival with interventions; and secondary patency, defined as cumulative access survival. Results We identified 15 comparative studies reporting a total of 118,434 patients who initiated haemodialysis with AVF ( n = 95,143) or AVG ( n = 23,291). Our analysis demonstrated that AVF was associated with significantly higher primary failure rate (OR: 2.05, p = .0005) but significantly higher rate of primary patency at 1 year (OR: 1.91, p < .00001), at 2 years (OR: 2.52, p < .00001) and at 5 years (OR: 2.59, p < .00001); and primary-assisted patency at 1 year (OR: 1.71, p < .00001), at 2 years (OR: 2.13, p < .00001) and 5 years (OR: 2.79, p < .00001). There was no significant difference in secondary patency at 1 year (OR: 1.08, p < .00001) but AVF had better secondary patency at 2 years (OR: 1.26, p < .00001) and 5 years (OR: 1.60, p < .00001) than AVG. Conclusions The meta-analysis of best available comparative evidence (Level 2) demonstrated that AVFs may be associated with significantly higher primary failure rate but higher primary patency, primary-assisted patency and secondary patency at 1, 2 and 5 years compared to AVGs. However, the available evidence is subject to significant selection bias and confounding by indication.

The usefulness and feasibility of placing a clinch knot with a guidewire to achieve temporary hemostasis in arteriovenous dialysis access interventions

2020 ◽  
pp. 112972982095474
Author(s):  
Sung-Joon Park ◽  
Hwan Hoon Chung ◽  
Seung Hwa Lee ◽  
Sung Beom Cho ◽  
Tae-Seok Seo ◽  
...  
Keyword(s):  
Clinical Success ◽  
Primary Patency ◽  
Interventional Treatment ◽  
Secondary Patency ◽  
Dialysis Access ◽  
Hemodialysis Access ◽  
Purse String Suture ◽  
Purse String ◽  
Arteriovenous Fistulas ◽  
Arteriovenous Grafts

Purpose: To evaluate the usefulness and feasibility of using a reversible clinch knot with a guidewire in place rather than eliminating the access route during an arteriovenous hemodialysis access (AV access) intervention using the facing sheath technique. Material and methods: From July 2016 to June 2019, we retrospectively studied 78 sessions performed as interventional treatment for arteriovenous (AV) hemodialysis (HD) access using the “facing-sheath technique.” In all sessions, all antegrade sheaths were removed while a 0.035-inch guidewire remained in place with purse-string suture and the clinch knot. Seventy-two sessions were performed in patients with thrombosed AV accesses (69 arteriovenous grafts [AVGs] and three arteriovenous fistulas [AVFs]), and six sessions were carried out to treat non-thrombosed AV accesses (four AVGs and two AVFs). We evaluated whether proper hemostasis and successful reinsertion of the sheath over the wire into the clinch knot was achieved. Clinical success was defined as achieving prompt restoration of blood flow for AV access, and the postintervention primary and secondary patency were also evaluated. Result: In all 87 clinch knots created in 78 total sessions, proper hemostasis was achieved. All clinch knots that required reversal for additional procedures were successfully reopened (55 clinch knots in 50 sessions). The postintervention primary patency rates at 1, 3, and 6 months, and at 1 year were 77.8%, 68.9%, 55.6%, and 33.3%, respectively. The postintervention secondary patency rates at 1, 3, and 6 months, and also at 1 year were 93.3%, 91.1%, 86.7%, and 86.7%, respectively. Conclusion: Our AV access intervention which used a clinch knot with purse-string suture while the guidewire remained in place was both useful and feasible for maintaining temporary hemostasis.

Alternative Tendon Coaptations to the Pulvertaft Weave Technique: A Systematic Review and Meta-Analysis of Biomechanical Studies

Hand ◽  
2021 ◽  
pp. 155894472110432
Author(s):  
Emily M. Graham ◽  
Jeremie D. Oliver ◽  
Russell Hendrycks ◽  
Dino Maglic ◽  
Shaun D. Mendenhall
Keyword(s):  
Systematic Review ◽  
Yield Strength ◽  
Random Effects ◽  
Meta Analysis ◽  
Dichotomous Data ◽  
Inverse Variance ◽  
Significant Difference ◽  
Alternative Techniques ◽  
Meta Analyses

Background The Pulvertaft weave technique (PT) is frequently used during tendon repairs and transfers. However, this technique is associated with limitations. In this systematic review and meta-analysis, quantitative and qualitative analyses were performed on in vitro, biomechanical studies that compared the PT with alternative techniques. Methods Articles included for qualitative and/or qualitative analysis were identified following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies included in the meta-analysis were analyzed either as continuous data with inverse variance and random effects or as dichotomous data using a Mantel-Haenszel analysis assuming random effects to calculate an odds ratio. Results A comprehensive electronic search yielded 8 studies meeting inclusion criteria for meta-analysis. Two studies with a total of 65 tendon coaptations demonstrated no significant difference in strength between the PT and traditional side-to-side (STS) techniques ( P = .92). Two studies with a total of 43 tendon coaptations showed that the STS with 1 weave has a higher yield strength than the PT ( P = .03). Two studies with a total of 62 tendon repairs demonstrated no significant difference in strength between the PT and the step-cut (SC) techniques ( P = .70). The final 2 studies included 46 tendon repairs and demonstrated that the wrap around (WA) technique has a higher yield strength than the PT ( P < .001). Conclusions The STS, SC, and WA techniques are preferred for improving tendon form. The STS and WA techniques have superior yield strengths than the PT, and the SC technique withstands similar stress to failure as the PT.

MILLER Banding Procedure for Treatment of Dialysis Access–Related Steal Syndrome, Pulmonary Hypertension, and Heart Failure

2021 ◽  
pp. 000313482110562
Author(s):  
Ahmad Alqassieh ◽  
Patrick B. Dennis ◽  
Veena Mehta ◽  
June Shi ◽  
Angello Lin ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Vascular Access ◽  
Primary Patency ◽  
Secondary Patency ◽  
Dialysis Access ◽  
Long Term Follow Up ◽  
Steal Syndrome

A Minimally Invasive Limited Ligation Endoluminal-assisted Revision (MILLER) banding procedure has been used for treating patients with dialysis access–related steal syndrome (DASS) and high-flow vascular access–related pulmonary hypertension (PHT) and heart failure (HF). We performed a retrospective analysis of patients undergoing the MILLER procedure performed for DASS, HF, and PHT from our Vascular Access Database from September 2017 to October 2019. Outcomes included primary patency of banding, primary assisted patency, and secondary patency, using time-to-event analyses with Kaplan-Meier curves and life tables to estimate 6- and 12-month rates. A total of 13 patients (6 men and 7 women, mean age 60 ± 14 years) underwent the MILLER procedure, 6 patients for DASS and 7 patients for pulmonary hypertension and heart failure (PHT/HF). Technical success was achieved in all patients. The longest duration of follow-up was 28 months (median 12 months [IQR 7, 19]). One patient died at 1 month after the intervention due to stroke. One patient developed access thrombosis of the graft 3 days after the procedure. Repeat banding was required in 1 patient 8 months after the first procedure. The 6-month primary patency rate of banding following this procedure was 83% while the 12-month rate was 66%. The 6- and 12-month secondary patency rates were 87% and 75%, respectively. The MILLER procedure can be performed for DASS and PHT/HF with improvement of symptoms and good long-term patency rates. Additional interventions to maintain patency and efficacy are required on long-term follow-up.

Medical visit time and predictors in health facilities: a mega systematic review and meta-analysis

2019 ◽  
Vol 12 (5) ◽  
pp. 373-402 ◽  
Author(s):  
Sakineh Hajebrahimi ◽  
Ali Janati ◽  
Morteza Arab-Zozani ◽  
Mobin Sokhanvar ◽  
Elaheh Haghgoshayie ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Visit Time ◽  
Medical Visit ◽  
High Quality ◽  
Content Type ◽  
Face To Face ◽  
Significant Difference ◽  
Meta Analyses

Purpose Visit time is a crucial aspect of patient–physician interaction; its inadequacy can negatively impact the efficiency of treatment and diagnosis. In addition, visit time is a fundamental demand of patients, and it is one of the rights of every patient. The purpose of this paper is to determine factors influencing the consultation length of physicians and to compare consultation length in different countries. Design/methodology/approach MEDLINE (PubMed), Web of Science, Cochrane, ProQuest, Scopus, and Google Scholar were searched. In addition, references of references were checked, and publication lists of individual scholars in the field were examined. We used data sources up to June 2018, without language restriction. We used a random-effects model for the meta-analyses. Meta-analyses were conducted using Comprehensive Meta-Analysis Version (CMA) 3.0. Findings Of 16,911 identified studies, 189 studies were assessed of which 125 cases (67 percent) have been conducted in the USA. A total of 189 studies, 164 (86.77 percent) involved face-to face-consultations. The effects of three variables, physician gender, patient gender, and type of consultation were analyzed. According to moderate and strong evidence studies, no significant difference was found in the consultation lengths of female and male doctors (Q=42.72, df=8, I2=81.27, p=0.891) and patients’ gender (Q=55.98, df=11, I2=80.35, p=0.314). In addition, no significant difference was found in the telemedicine or face-to-face visits (Q=41.25, df=5, I2=87.88, p=0.170). Originality/value In this systematic review and meta-analysis, all of physicians’ visits in 34 countries were surveyed. The evidence suggests that specified variables do not influence the length of consultations. Good relationship is essential to a safe and high-quality consultation and referral process. A high-quality consultation can improve decisions and quality of visits, treatment effectiveness, efficiency of service, quality of care, patient safety and physician and patient satisfaction.

Neutropenic diets to prevent cancer infections: updated systematic review and meta-analysis

2019 ◽  
pp. bmjspcare-2018-001742 ◽  
Author(s):  
Mohamad Bassam Sonbol ◽  
Tania Jain ◽  
Belal Firwana ◽  
Talal Hilal ◽  
Thomas Deleon ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Cell Transplant ◽  
Regular Diet ◽  
Patients With Cancer ◽  
Transplant Patients ◽  
Haematopoietic Cell ◽  
Significant Difference ◽  
Neutropenic Patients ◽  
Meta Analyses

IntroductionMultiple studies have questioned the benefit of neutropenic diets in decreasing infections in patients with cancer, but recent surveys showed that such diets are still prescribed. In this study, we sought to evaluate the effectiveness of neutropenic diet in decreasing infection and mortality in neutropenic patients with cancer with neutropenia. This review is an update of a previously published systematic review.Materials and methodsWe searched different databases to identify comparative studies that investigated the effect of neutropenic diet compared with regular diet in neutropenic adults and children with cancer. We conducted random‐effects meta‐analyses using the Der‐Simonian and Laird method to pool treatment effects from included studies. Outcomes of interest were mortality, bacteremia/fungemia, major infections, quality of life, and the composite outcome for neutropenic fever and/or infection.ResultsWe included six studies (five randomised) with 1116 patients, with 772 (69.1%) having underwent haematopoietic cell transplant. There was no statistically significant difference between neutropenic diet and regular diet in the rates of major infections (relative risk [RR] 1.16; 95% CI 0.94 to 1.42) or bacteremia/fungemia (RR 0.96; 95% CI 0.60 to 1.53). In haematopoietic cell transplant patients, neutropenic diet was associated with a slightly higher risk of infections (RR 1.25; 95% CI 1.02 to 1.54). No difference in mortality was seen between neutropenic diet and regular diet (RR 1.08, 95% CI 0.78 to 1.50).ConclusionThere is currently no evidence to support the use of neutropenic diet or other food restrictions in neutropenic patients with cancer. Patients and clinicians should continue to follow the safe food-handling guidelines as recommended by the U.S. Food and Drug Administration.

scholarly journals Efficacy of Oral Ginger (Zingiber officinale) for Dysmenorrhea: A Systematic Review and Meta-Analysis

2016 ◽  
Vol 2016 ◽  
pp. 1-10 ◽  
Author(s):  
Chen X. Chen ◽  
Bruce Barrett ◽  
Kristine L. Kwekkeboom
Keyword(s):  
Systematic Review ◽  
Methodological Quality ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Grey Literature ◽  
Zingiber Officinale ◽  
Mean Difference ◽  
Significant Difference ◽  
Meta Analyses

This systematic review examines the efficacy of oral ginger for dysmenorrhea. Key biomedical databases and grey literature were searched. We included randomized controlled trials comparing oral ginger against placebo or active treatment in women with dysmenorrhea. Six trials were identified. Two authors independently reviewed the articles, extracted data, and assessed risk of bias. Discrepancies were resolved by consensus with a third reviewer. We completed a narrative synthesis of all six studies and exploratory meta-analyses of three studies comparing ginger with placebo and two studies comparing ginger with a nonsteroidal anti-inflammatory drug (NSAID). Ginger appeared more effective for reducing pain severity than placebo. The weighted mean difference on a 10 cm visual analogue scale was 1.55 cm (favoring ginger) (95% CI 0.68 to 2.43). No significant difference was found between ginger and mefenamic acid (an NSAID). The standardized mean difference was 0 (95% CI −0.40 to 0.41). Available data suggest that oral ginger could be an effective treatment for menstrual pain in dysmenorrhea. Findings, however, need to be interpreted with caution because of the small number of studies, poor methodological quality of the studies, and high heterogeneity across trials. The review highlights the need for future trials with high methodological quality.

scholarly journals Effect of periodontal therapy on the systemic inflammation and metabolic  markers in patients undergoing hemodialysis or/and peritoneal dialysis: a systematic review and meta-analysis

2019 ◽  
Author(s):  
Hui Yue ◽  
Xinxin Xu ◽  
Qin Liu ◽  
Xiaozhi Li ◽  
Yiting Xiao ◽  
...  
Keyword(s):  
Systematic Review ◽  
Peritoneal Dialysis ◽  
Assessment Tool ◽  
Meta Analysis ◽  
Cochrane Collaboration ◽  
Periodontal Treatment ◽  
Sufficient Evidence ◽  
Metabolic Markers ◽  
Significant Difference ◽  
Meta Analyses

Abstract Background: This systematic review aimed to investigate whether periodontal treatment can reduce the systemic inflammatory levels and improve the metabolic levels in patients undergoing hemodialysis (HD) or/and peritoneal dialysis (PD). Methods: Electronic databases (PubMed, EMBASE, CENTRAL, NCKI, and WFPD) were searched up to July 2019. The risk of bias within studies was assessed through the Cochrane Collaboration' s risk assessment tool. The systemic inflammatory and metabolic measures were the highly sensitive C-reactive protein (hs-CRP), interleukin 6 (IL-6), tumor necrosis factor-α (TNF-a), the albumin (Alb), and lipid metabolic levels. Meta-analyses (MAs) were performed to calculate the overall effect size where appropriate. Results: Five studies were eligible for this systematic review. The result of four studies revealed a significant difference in the CRP level after periodontal treatment in patients receiving HD or/and PD. Two studies reported the IL-6 and the Alb level after periodontal treatment but revealed no significant difference. No MAs could be performed on the TNF- a level and the lipid metabolic markers. Conclusions: Periodontal treatment may moderately reduce the serum of CRP levels in HD or/and PD patients. For the TNF-a, IL-6, Alb levels and lipid metabolic markers, no sufficient evidence supports the difference after periodontal treatment. Therefore, larger scales and high-quality randomized-controlled trials (RCTs) are required to assess the effect of periodontal treatment on systemic inflammatory and metabolic parameters in HD or/and PD patients.

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