This SAIMSARA review maps 261 original studies comparing AVF and AVG for hemodialysis access, showing where fistulas dominate on durability, infection, mortality, and cost — and where grafts may be clinically preferable for frail, catheter-dependent, or poor-vein patients. The full evidence map gives humans and LLMs a structured, reference-linked view of patency, complications, survival, economics, patient subgroups, and access-selection trade-offs — ready for clinical reading, reasoning, and machine-readable evidence use.
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Abstract: The aim of this scoping review is to synthesize contemporary evidence comparing arteriovenous fistulas and arteriovenous grafts regarding their patency rates, complication profiles (including infection and thrombosis), economic impact, and suitability across diverse patient demographics. The review utilises 261 original studies with 4335091 total participants (topic deduplicated ΣN). Across the mapped evidence, arteriovenous fistulas emerged as the dominant access type for long-term durability, with 12-month primary patency ranging from approximately 62.2% to 89% versus 46.0% to 56% for grafts, and infection event rates roughly half those seen with grafts (0.17–0.26 vs 0.35–0.39 per 100 patient-months). Recurrent topic-level signals also indicated lower mortality, fewer maintenance interventions, and lower access-related costs for AVFs, while AVGs offered earlier usability, more reliable cannulation in catheter-dependent or frail patients, and a viable salvage role when superficial veins were exhausted. Mechanistic and adjunctive themes, including higher thrombosis hazards with grafts, greater inflammatory response after AVG placement, and modifying effects of antiplatelet therapy, sex, race, diabetes, and frailty, support a more individualized rather than uniformly fistula-first selection strategy. The map is constrained by predominantly retrospective evidence and heterogeneous outcome definitions, so the synthesis should be interpreted as a directional signal rather than a definitive comparative effect. Practically, these findings support prioritizing AVF creation when anatomy and life expectancy permit, while reserving AVGs for patients in whom prolonged catheter exposure or maturation failure is the dominant risk. Future research should focus on prospective, patient-centered decision tools that integrate frailty, vessel mapping, and life expectancy to refine when an AVG is preferable to an AVF and to standardize outcome reporting across access modalities.
Final search date and database lock: 2026-05-06 22:25:53 CEST
Plan: Pro (expanded craft tokens; source: PubMed)
Source: PubMed
Total Abstracts/Papers: 1094
Downloaded Abstracts/Papers: 1094
Included original and non-original Abstracts/Papers (all): 281
Included original Abstracts/Papers (Vote counting by direction of effect): 261
Reference Index (links used in paper): 119
Total participants (topic deduplicated ΣN): 4335091
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The Evidence Object JSON is a separate machine-readable evidence product: a concentrated synthesis of results, topic-level evidence, and discussion across original and non-original studies. It can be directly input into your LLM, agent, or RAG workflow.
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[273] Results of a hemodialysis vascular access routine ultrasound surveillance protocol and frequency of surveillance guided pre-emptive access maintenance interventions. — https://doi.org/10.1177/11297298231207427
[274] The first 365 days on haemodialysis: variation in the haemodialysis access journey and its associated burden. — https://doi.org/10.1093/ndt/gfx380
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