The review included 15 studies: two prospective, 10 retrospective and three of unstated design). No randomised controlled trials (RCTs) were identified. Studies included at least 656 patients with 782 accesses; 660 were upper-thigh grafts, 60 were mid-thigh grafts and 62 were femoral vein transposition arteriovenous fistulae.
Overall weighted mean primary patency rates were 53% at 12 months and 37% at 24 months; secondary patency rates were 71% at 12 months and 60% at 24 months. The 12-month patency rates of femoral vein transposition arteriovenous fistulae (83%) were better than those of upper-thigh (48%) and mid-thigh (43%) grafts.
Complication rates were similar for upper and mid-thigh arteriovenous access. Infection rates were significantly lower in femoral vein transposition than either mid-thigh (OR 0.073, 95% CI 0.009 to 0.585) or upper thigh (OR 0.073, 95% CI 0.010 to 0.531) accesses. Steal rates were higher: OR 2.388 (95% CI 0.842 to 6.767) compared to mid-thigh and OR 3.543 (95% CI 1.738 to 7.222) compared to upper thigh.
Grade 2 infection was significantly less frequent in autologous compared to prosthetic grafts (OR 0.073, 95% CI 0.010 to 0.530) and steal was more frequent (OR 3.427, 95% CI 1.707 to 6.881).
The amputation rate following arteriovenous access creation ranged from 0% and 7% (seven studies).