https://doi.org/10.1177/1129729818814466 The Journal of Vascular Access 1–11 © The Author(s) 2018 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/1129729818814466 journals.sagepub.com/home/jva JVA Te Journal of Vascular Access Introduction The surgically created arteriovenous fistula (AVF) is the most reliable form of vascular access for end-stage renal failure (ESRF) patients dependent on hemodialysis. 1 The radiocephalic fistula (RCF) is associated with excellent clinical outcomes with multiple venous outflows: the cephalic vein, the basilic vein, and the deep venous sys- tem. This allows for longer access survival, lower throm- bosis rates, fewer access-related hospitalizations, and lower costs than AVFs at alternative sites. 2 However, when Endovascular treatment of cephalic arch stenosis in brachiocephalic arteriovenous fistulas: A systematic review and meta-analysis Reuban Toby D’cruz 1 , Sze Wai Leong 1 , Nicholas Syn 2 , Alok Tiwari 3 , Vikram Vijayan Sannasi 1 , Harvinder Raj Singh Sidhu 1 and Tjun Yip Tang 4 Abstract Purpose: The aim of this study is to appraise the current literature on the endovascular management options and their outcomes of cephalic arch stenosis in the setting of a failing brachiocephalic fistula for hemodialysis. Methods: A systematic search of the literature was performed using PubMed, Embase, and Google Scholar from January 2000 to December 2017 in accordance with the PRISMA guidelines to investigate the outcomes of endovascular management of cephalic arch stenosis. Data from randomized controlled trials and observational studies, published in the English language, were extracted to determine pooled proportion of primary and secondary patency, using a random- effects meta-analysis. Subgroup analyses of stent grafts, bare metal stents, and percutaneous transluminal angioplasty outcomes were performed. Results: Of the 125 total studies, 11 were included for analysis by consensus. Overall, 457 patients were reviewed and analyzed for primary and secondary patency rates at 6 and 12 months post-treatment. There was significantly higher primary patency at both 6 and 12 months in the stent graft group compared to those who received bare metal stents or percutaneous transluminal angioplasty (relative risk = 0.30–0.31, relative risk = 0.34–0.59, respectively; p < 0.01). Higher secondary patency rates were noted in the bare metal stents cohort compared to the percutaneous transluminal angioplasty cohort at 12 months (relative risk = 0.17, 95% confidence interval = 0.07–0.26; p < 0.01). Conclusion: This study demonstrated a significant benefit in using stent grafts in cephalic arch stenosis compared to bare metal stents or percutaneous transluminal angioplasty with higher primary and secondary patency rates. Keywords Angioplasty, cephalic arch stenosis, endovascular, stenting Date received: 13 May 2018; accepted: 30 October 2018 1 Department of Surgery, Ng Teng Fong General Hospital, Singapore 2 Yong Loo Lin School of Medicine, National University of Singapore, Singapore 3 Department of Vascular Surgery, Queen Elizabeth Hospital, Birmingham, UK 4 Department of Vascular Surgery, Singapore General Hospital, Singapore Corresponding author: Reuban Toby D’cruz, Department of Surgery, Ng Teng Fong General Hospital, 1 Jurong East Street 21, Singapore 609606, Singapore. Email: reuban.dcruz@gmail.com 814466JVA 0 0 10.1177/1129729818814466The Journal of Vascular AccessD’cruz et al. review-article 2018 Review