Comparison of End-To-Side and Side-To-Side Anastomosis Techniques in Arteriovenous Fistula for Hemodialysis: A Systematic Review and Meta-Analysis.

Autogenous arteriovenous fistula (AVF) is the vascular access of choice for chronic kidney disease to patients requiring hemodialysis. However, there still needs to be more consensus on whether the best surgical approach is an end-to-side (ETS) or a side-to-side (STS) anastomosis. This study aims to compare venous maturation rates, midterm patency and postoperative steal syndrome rates between ETS and STS techniques for AVFs. Three databases were searched during November 2022: PubMed, Scopus, and ISI Web of Knowledge. Two independent reviewers examined both titles and abstracts. In all studies, eligibility was assessed, and data regarding the study's characteristics, methods, and considered outcomes were obtained. The odds ratio (OR) assessed maturation rates, 6- and 12-month patency, and steal syndrome. Meta-analysis was done using a fixed effects model if I2 values were under 30%, and a random-effects model from 30-60%. Thirteen studies were included, with a total of 1960 patients studied. Patients undergoing ETS anastomosis had higher maturation rates (OR 3.30 95% confidence interval [CI] 1.81, 6.00, I2 = 20%). No difference was found in patency at 6 months (OR 1.05 95% CI 0.69, 1.59, I2 = 54%) and 12 months (OR 0.75 95% CI 0.46, 1.23, I2 = 7%). Regarding steal syndrome, STS anastomosis presented a greater risk of developing this postoperative complication (OR 0.24 95% CI 0.11, 0.50, I2 = 0%). The present review suggests that ETS anastomosis is associated with higher maturation rates and a lower risk of arterial steal syndrome. Randomized clinical trials are required to confirm our findings.