Early cannulation grafts for haemodialysis: An updated systematic review

Purpose: Early cannulation grafts are specifically designed for dialysis, whereas standard expanded polytetrafluoroethylene grafts were not. There is developing collective experience and literature available to allow the assessment of outcomes of these early cannulation grafts. The aim of this review was to review the evidence for both short- and long-term outcomes of early cannulation grafts. Methods: Using standardized searches of electronic databases in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses, the primary outcomes for this study were primary and secondary patency rates for early cannulation grafts for dialysis at 12 months and beyond. Secondary outcomes were timing of first cannulation, rates of access thrombosis, steal syndrome, pseudo-aneurysm and infection. Results: A total of 19 studies were identified and included. These were divided into different graft types. Flixene (TM), Avflo (TM), Acuseal (TM) and Vectra (TM) grafts all showed that early cannulation within 72 h is possible. Twelve-month pooled primary and secondary patency rates were 43.3% (95% confidence interval: 31.6-55.4) and 73.4% (95% confidence interval: 63-82.7) for the Flixene graft, 58.2% (95% confidence interval: 48-68.1) and 79.2% (95% confidence interval: 68-88.7) for the Avflo graft, 43.6% (95% confidence interval: 30.7-56.9) and 70.5% (95% confidence interval: 49.7-87.8) for the Acuseal graft and 63.7% (95% confidence interval: 53.4-73.4) and 85.8% (95% confidence interval: 82.9-88.4) for the Vectra graft. Data for outcome beyond 12 months were limited to the more recent studies. Conclusion: This review confirms that early cannulation is not detrimental on the early outcome of early cannulation graft patencies. It has also shown that both Vectra and Avflo grafts have adequate long-term patencies. The data do not allow specific graft recommendations, as comparative trials would be required.