Endovascular arteriovenous fistula: Outcomes and comparison with surgical arteriovenous fistula: An updated systematic review and meta-analysis

Abstract

Endovascular arteriovenous fistula (eAVF) creation is a minimally invasive alternative to traditional surgical arteriovenous fistula (sAVF) for hemodialysis access. We conducted a systematic review and meta-analysis to evaluate the clinical outcomes of eAVF and compare them with those of sAVF. A total of 28 studies were included, comprising 20 single-arm eAVF studies and 8 comparative studies, identified through searches of PubMed, MEDLINE, Web of Science, ScienceDirect, Google Scholar, and Cochrane CENTRAL from inception to February 1, 2025. Outcomes assessed included technical success, maturation rate, primary patency, reintervention, and complications. The pooled technical success rate of eAVF was 97%, with a maturation rate of 77%. Primary patency rates were 64% at 6 months and 77% at 12 months. The overall complication rate was low (9%), although moderate to high heterogeneity was observed across several outcomes. Device subgroup analyses demonstrated numerical differences between Ellipsys and WavelinQ systems with overlapping confidence intervals. In comparative studies, no statistically significant differences were observed in maturation rate or primary patency; however, eAVF was associated with numerically higher reintervention rates and lower complication rates. These findings suggest that eAVF represents a safe and effective alternative to surgical AVF in appropriately selected patients, while highlighting the importance of careful patient selection and post-procedural surveillance given the heterogeneity of existing evidence.