Optimal Patency and Complication Outcomes of Autogenous Arteriovenous Fistulae for Haemodialysis Access: A Systematic Review and Meta-analysis

Background Arteriovenous fistulae (AVFs) are the gold standard for vascular access in haemodialysis because of better long-term outcomes than with grafts or catheters. With physiological benefits, heterogeneity in maturation and patency results requires thorough assessment. Objective To integrate current evidence regarding patency, complication rates, and predictors of autogenous AVF function in adult haemodialysis patients. Methods Systematic review and meta-analysis, adhering to PRISMA 2020 guidelines and PROSPERO registration, were undertaken. Evidence from 2020 to 2025 regarding adult ESRD patients with AVFs was included. Data were independently extracted and synthesized with random-effects models. Subgroup and meta-regression analyses tested configuration, geography, and perioperative factors. GRADE evaluated evidence certainty. Results Ten studies (n > 10,000 patients) were analyzed. The brachio-cephalic AVFs provided the greatest 12- and 24-month patency (66%, 83%) with minimal maturation failure (16%). Regional differences demonstrated better results in the Asia-Pacific. Preoperative mapping, intraoperative ultrasound, and organized postoperative monitoring significantly enhanced outcomes. Primary patency was 49–72%; secondary patency was more than 80% in the majority of cohorts. Conclusions Autogenous AVFs, especially brachio-cephalic, provide long-lasting, safe dialysis access when used with optimized perioperative care. Geographic and procedural heterogeneity emphasize the importance of standardized protocols and individualized access planning.