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Whether a TBBAVF or AVG is the preferential alternative to the conventional AVF remains controversial. In 2008, Lazarides et al. [13] evaluated the difference in clinical outcomes between TBBAVF and AVG in a meta-analysis of 11 studies (1 randomized controlled trial [RCT] and 10 retrospective studies) involving a total of 1,135 patients. The pooled estimated ORs for the primary and secondary failure rates at 1 year were 0.67 (CI 0.41–1.09) and 0.88 (CI 0.69–1.12), respectively, showing no difference in the outcome between the 2 groups. In 8 studies, however, the re-intervention rate was higher for prosthetic grafts (0.54 per TBBAVF vs. 1.32 per graft) [13]. The most recent RCT by Davoudi et al. [14] in 2013 also demonstrated no statistically significant difference in the mean primary patency time or access-related complication rate at 1 year between the 2 techniques. Several recent cohort studies published since 2008 have assessed the differences in various clinical outcomes between these 2 VA options. On the whole, TBBAVF offers a compatible or better patency rate, fewer infection-related complications, a lower rate of long-term adverse events, and a lower requirement for interventions, all of which should contribute to the higher cost-effectiveness of TBBAVF than AVG. However, AVG requires a shorter length of hospital admission, total intervention time, and mean interval to the first cannulation than TBBAVF, which could be beneficial for older patients with a short life expectancy and urgent need for VA or patients with compromised clinical conditions and unreliability for temporary VA [4, 5] (Table 1).

Table 1. Recent comparative studies of TBBAVF versus AVG