Arterioarterial grafts show high patency in hemodialysis patientsArterioarterial grafts show strong patency and low risks for hemodialysis patients with exhausted access sites

The journal of vascular access Published May 4, 2026 Study authors: Alatefi Dawood, Alanzi Ahmed K, Alkabazi Malik, Elshiekh Mohamed O, Alshokri Mabrouka M, Bakeer Hiba… PubMed ↗ DOI ↗ Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

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Key Takeaway

Arterioarterial grafts offer high patency and low complications for hemodialysis access salvage.

A systematic review and meta-analysis of 514 hemodialysis patients evaluated arterioarterial grafts (AAGs) for vascular access. The analysis pooled data from 521 procedures to assess primary and secondary patency rates over time.

Primary patency was 92% at six months, declining to 76% at twelve months and 50% at thirty-six months. Secondary patency remained high, at 97% at six months and 75% at thirty-six months. Early complication rates were low: infection 3%, thrombosis 4%, hematoma 5%, bleeding 9%, and edema 4%.

These findings suggest AAGs are a viable salvage option for patients with exhausted access sites, central venous stenosis, or cardiac comorbidities. The grafts avoid venous shunting and excessive preload, potentially improving safety.

Limitations include inconsistent evidence on long-term durability and the need for larger multicenter studies to validate outcomes and optimize surgical selection. The analysis did not report absolute patient numbers or direct comparators.

Practice relevance highlights AAGs as a safe alternative for high-risk hemodialysis patients, though long-term data remain uncertain. Causality cannot be inferred from this association.

This study looked at arterioarterial grafts used for hemodialysis patients who had no other access options. The team reviewed data from 514 patients who had these procedures done. They checked how long the new access lasted and looked for early complications.

At six months, about 92% of the grafts were still working well. By one year, 76% remained open. Even at three years, half of the grafts were still functioning. Secondary patency, meaning the graft stayed open even if it needed a fix, was very high at 97% after six months.

Early problems were rare but included infection, clots, bleeding, and swelling. Infection happened in 3% of cases, while bleeding occurred in 9%. Most patients tolerated the procedure well without serious issues or needing to stop using the access.

Experts say these grafts are a safe choice for high-risk patients. They avoid putting too much pressure on the heart. However, more large studies are needed to confirm long-term results and help doctors choose the best surgical option for each person.

What this means for you:

Arterioarterial grafts offer durable access with low complication rates for hemodialysis patients with exhausted sites.

Study Details

Study typeMeta analysis

Sample sizen = 514

EvidenceLevel 1

PublishedMay 2026

PMID41208275

View Original Abstract ↓

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%; ² = 58.6%), 76% at 12 months (95% CI: 69%-84%; ² = 74.7%), 71% at 18 months (95% CI: 62%-80%; ² = 2.4%), 67% at 24 months (95% CI: 59%-75%; ² = 0.7%), and 50% at 36 months (95% CI: 40%-61%; ² = 2.3%). Corresponding secondary patency rates were 97% at 6 months (95% CI: 95%-99%; ² = 0%), 92% at 12 months (95% CI: 89%-95%; ² = 41.6%), and 75% at 36 months (95% CI: 64%-87%; 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.

Arterioarterial grafts show high patency in hemodialysis patientsArterioarterial grafts show strong patency and low risks for hemodialysis patients with exhausted access sites

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Arterioarterial grafts show high patency in hemodialysis patientsArterioarterial grafts show strong patency and low risks for hemodialysis patients with exhausted access sites

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