Evaluating patency rates and complications of arterioarterial grafts in patients undergoing hemodialysis: A systematic review and meta-analysis

Background: Arterioarterial graft (AAG) access offers an alternative vascular route for hemodialysis patients unsuitable for conventional arteriovenous access. Evidence on its long-term durability and safety remains inconsistent. This systematic review and meta-analysis evaluated the patency and complication rates of AAGs in hemodialysis. Methods: Following PRISMA guidelines (PROSPERO CRD42024623593), PubMed, Scopus, VHL, Embase, Web of Science, and Google Scholar were searched for studies reporting AAG outcomes in humans. Primary outcomes were primary and secondary patency rates; secondary outcomes included early complications. Data were pooled using random-effects models with logit transformation, and study quality was assessed with the MINORS tool. Results: Twenty-one studies comprising 514 patients (521 procedures; mean age 55 years; 50% male) were included. Pooled primary patency rates were 92% at 6 months (95% CI: 88%–96%; I ² = 58.6%), 76% at 12 months (95% CI: 69%–84%; I ² = 74.7%), 71% at 18 months (95% CI: 62%–80%; I ² = 2.4%), 67% at 24 months (95% CI: 59%–75%; I ² = 0.7%), and 50% at 36 months (95% CI: 40%–61%; I ² = 2.3%). Corresponding secondary patency rates were 97% at 6 months (95% CI: 95%–99%; I ² = 0%), 92% at 12 months (95% CI: 89%–95%; I ² = 41.6%), and 75% at 36 months (95% CI: 64%–87%; I ² = 43.6%). Early complications were infrequent: infection 3% (95% CI: 2%–6%), thrombosis 4% (95% CI: 1%–9%), hematoma 5% (95% CI: 2%–15%), bleeding 9% (95% CI: 4%–17%), and edema 4% (95% CI: 0%–99%). Conclusions: AAGs demonstrate high patency and low complication rates in high-risk hemodialysis patients with exhausted access sites, central venous stenosis, or cardiac comorbidities. By avoiding venous shunting and excessive preload, AAG represents a safe salvage access. Larger multicenter studies are needed to validate long-term outcomes and optimize surgical selection.