Staged versus synchronous surgical management of multiple arteriovenous fistula aneurysms: A systematic review

Multiple arteriovenous fistula aneurysm (AVF-An) repair is critical for maintaining access, but the optimal surgical approach (synchronous (one-stage) vs staged (two-stage)) remains uncertain. Our aim is to compare one-stage and two-stage surgical repair of multiple AVF-An regarding patency and complications. We conducted a systematic review following PRISMA guidelines, searching PubMed and Scopus databases up to 2025. Eligible studies compared one-stage and two-stage repair of multiple AVF-An, providing data on patency and complications. Inclusion criteria targeted studies with data on primary, assisted primary, and secondary patency, postoperative central venous catheter (CVC) use, complications, and reinterventions. Data were extracted independently, and the quality of studies included in the review were assessed using the Newcastle-Ottawa (NOS) scale. Three studies were included. The two-stage approach showed a tendency toward lower postoperative CVC use, higher primary patency, higher secondary patency, and reduced reinterventions. Two-stage repair had fewer short- and long-term complications. Central venous stenoses were associated with aneurysm formation and recurrence. In conclusion, two-stage repair may offer superior patency and fewer complications, likely due to preserved access during healing. However, limited studies, lack of randomization, and non-significant results limit conclusions.