Hemodialysis Vascular Access: AVF vs. AVG Outcomes

Abstract

Introduction: Arteriovenous fistula (AVF) is recommended over arteriovenous graft (AVG) for hemodialysis, but comparative patency and complication rates remain debated. Methods: Meta-analysis of 22 observational studies (n=12,450 patients) comparing primary and secondary patency, thrombosis, and infection rates between AVF and AVG. Results: Primary patency at 1 year was higher for AVF (65% vs. 55%, p=0.02). Secondary patency showed no significant difference (85% vs. 82%). Infection rates were lower for AVF (5% vs. 15%, p<0.001), but maturation failure was higher (30% vs. 10%). Discussion: AVF offers long-term benefits if successful maturation is achieved. AVG may be preferred in elderly or diabetic patients with poor vasculature due to shorter maturation time. Conclusion: AVF remains first choice, but individualized access selection based on patient characteristics is critical.