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• W4286946266 abstract "We read the article by Malik et al1Malik M.H. Mohammed M. Kallmes D.F. Misra S. Endovascular versus surgical arteriovenous fistulas: a systematic review and meta-analysis.Kidney Med. 2021; 4100406https://doi.org/10.1016/j.xkme.2021.100406Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar with great interest; however, we have 2 concerns about their conclusion that states that percutaneous arteriovenous fistulas (AVFs) can be used safely in place of surgical AVFs. First, the authors1Malik M.H. Mohammed M. Kallmes D.F. Misra S. Endovascular versus surgical arteriovenous fistulas: a systematic review and meta-analysis.Kidney Med. 2021; 4100406https://doi.org/10.1016/j.xkme.2021.100406Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar may not have incorporated all relevant studies that compared the complications between percutaneous and surgical AVFs. Indeed, we found other studies2Yang S. Lok C. Arnold R. Rajan D. Glickman M. Comparison of post-creation procedures and costs between surgical and an endovascular approach to arteriovenous fistula creation.J Vasc Access. 2017; 18: 8-14https://doi.org/10.5301/jva.5000723Crossref PubMed Scopus (36) Google Scholar,3Arnold R.J.G. Han Y. Balakrishnan R. et al.Comparison between surgical and endovascular hemodialysis arteriovenous fistula interventions and associated costs.J Vasc Interv Radiol. 2018; 29: 1558-1566.e2https://doi.org/10.1016/j.jvir.2018.05.014Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar in addition to the included studies. The results of meta-analyses may be biased because of the lack of a comprehensive literature search. Second, they may overstate their conclusions given the large uncertainty of the evidence. Malik et al1Malik M.H. Mohammed M. Kallmes D.F. Misra S. Endovascular versus surgical arteriovenous fistulas: a systematic review and meta-analysis.Kidney Med. 2021; 4100406https://doi.org/10.1016/j.xkme.2021.100406Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar concluded that percutaneous AVF is a unique and safe alternative with outcomes comparable to surgical AVF; however, we challenge this claim by arguing that the wide 95% confidence intervals indicate the imprecision of the estimates.4Guyatt G.H. Oxman A.D. Kunz R. et al.GRADE guidelines 6. Rating the quality of evidence–imprecision.J Clin Epidemiol. 2011; 64: 1283-1293https://doi.org/10.1016/j.jclinepi.2011.01.012Abstract Full Text Full Text PDF PubMed Scopus (1424) Google Scholar According to the Grading of Recommendations Assessment, Development and Evaluation guidelines,4Guyatt G.H. Oxman A.D. Kunz R. et al.GRADE guidelines 6. Rating the quality of evidence–imprecision.J Clin Epidemiol. 2011; 64: 1283-1293https://doi.org/10.1016/j.jclinepi.2011.01.012Abstract Full Text Full Text PDF PubMed Scopus (1424) Google Scholar we evaluated the certainty of evidence for complications as very low because the included studies had small sample sizes and a serious risk of bias, mainly because of confounding. We suggest that the authors moderate their conclusions by acknowledging that the evidence is very uncertain about the effect of percutaneous AVF on complications. Additionally, given the fact that 1 of the authors had financial conflicts of interest with Medtronic, a manufacturer of the Ellipsys Vascular Access System, we would appreciate a careful discussion of the results. Notably, a prior study reported that systematic reviews with financial conflicts of interest are associated with misrepresentation of conclusions.5Hansen C. Lundh A. Rasmussen K. Hróbjartsson A. Financial conflicts of interest in systematic reviews: associations with results, conclusions, and methodological quality.Cochrane Database Syst Rev. 2019; 8MR000047https://doi.org/10.1002/14651858.MR000047.pub2Crossref PubMed Scopus (1) Google Scholar Received February 3, 2022. Direct editorial input from the Editor-in-Chief. Accepted in revised form March 14, 2022." @default.
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• W4286946266 date "2022-07-01" @default.
• W4286946266 modified "2023-10-16" @default.
• W4286946266 title "Assessing Evidence Quality for Endovascular Arteriovenous Fistulas" @default.
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