OBJECTIVE: Aneurysms arising from arteriovenous fistulae are a common finding among dialysed patients and pose a risk of acute bleeding. The aim of this study was to perform a systematic review and meta-analysis evaluating the surgical options for the treatment of aneurysmal arteriovenous fistulae. METHODS: A systematic review and meta-analysis of articles published between January 1973 and March 2019 describing the surgical treatment of arteriovenous fistulae aneurysms. RESULTS: A total of 794 records were identified. After duplicate and low quality studies were removed, 72 full text articles were reviewed and from these 13 were included in the meta-analysis. The total number of patients was 597. Aneurysms were located in the upper arm in 289 (59%) cases and the smallest diameter of a treated aneurysm was 15 mm. The most frequent indication for treatment was bleeding prevention in 513 (86%) cases. Aneurysmorrhaphy was the surgical method of choice in all 13 studies. The pooled primary patency at 12 months was 82% (95% CI 69%-90%, 12 studies, I2 = 84%, p < .01). The 12 month primary patency rates were similar for aneurysmorrhaphy with external prosthetic reinforcement (85%, 95% CI 71%-93%, two studies, I2 = 0%, p = .33) and aneurysmorrhaphy performed using a stapler (74%, 95% CI 61%-83%, four studies, I2 = 0%, p = .48) and without a stapler (82%, 95% CI 60%-94%, six studies, I2 = 92%, p < .01). CONCLUSION: Aneurysmorraphy of arteriovenous fistulae is a procedure with acceptable short and long term results, with a low complication and aneurysm recurrence rate.

Department of Anatomy 2nd Faculty of Medicine Charles University Prague Czech Republic

Department of Surgery Faculty Hospital Kralovske Vinohrady 3rd Faculty of Medicine Charles University Prague Czech Republic

Department of Transplant Surgery Belfast City Hospital UK

Department of Vascular Surgery National Institute for Cardiovascular Disease Bratislava Slovak Republic

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