Bovine Carotid Artery Grafts versus PTFE Grafts for Hemodialysis Access: A Systematic Review and Meta-Analysis

Arteriovenous grafts are considered for hemodialysis access in patients without a suitable vein for the creation of an arteriovenous fistula (AVF). The most commonly used synthetic polytetrafluorethylene (PTFE) graft carries a high risk of infection (6-29%) and limited biocompatibility. The bovine carotid artery graft (BCAG), a biological alternative, may address these limitations. This systemic review and meta-analysis compared the clinical outcomes of BCAG versus PTFE grafts.

MEDLINE, Embase, and Cochrane Library were searched for eligible studies (PROSPERO, no. 607603). Studies including patients with BCAG access were included, and those studies published before 2000 were excluded. If PTFE outcomes were reported, they were pooled for comparison. The primary outcome was (graft) infection. Secondary outcomes included primary, primary assisted and secondary patency, and postoperative complications. Meta-analyses and subgroup analyses used random-effects models.

Eleven studies (one randomized controlled trial (RCT) and 10 cohort studies) involving 1,247 patients met the inclusion criteria. Infection rates were similar between BCAG and PTFE (64 vs. 95 per 1,000 patient years; P = 0.43). At 12 months, BCAG showed significantly higher primary (47% vs. 29%; P = 0.02) and primary assisted patency (66% vs. 34%; P = 0.004). Secondary patency at 12 months was not significantly higher in the BCAG group (78% vs. 57%; P = 0.10). No differences were observed in the incidence of postoperative complications.

BCAG demonstrated superior primary and primary assisted patency compared to PTFE grafts in hemodialysis access. Other outcomes also favored BCAG but lacked statistical significance. Large-scale RCTs are warranted to further define the role of BCAG and support evidence-based decisions.