Abstract: Objective  To compare the patency rates and complications of brachiobasilic arteriovenous fistula (BBAVF) and upper extremity arteriovenous graft (AVG) as vascular access options, providing evidence to optimize tertiary vascular access selection.  Methods  We searched PubMed, the Cochrane Library, Embase, and ScienceDirect databases and manually screened the references. The Newcastle-Ottawa Scale was used to assess study quality. Data were extracted and a meta-analysis was performed to compare the one- and two-year patency rates and complication rates between BBAVF and AVG.  Results  A total of 24 studies were included. The BBAVF group demonstrated superior outcomes compared to the AVG group in terms of one-year primary (OR=1.837, 95% CI: 1.332～2.533, P＜0.001), assisted (OR=2.242, 95% CI: 1.439～3.494, P＜0.001), secondary (OR=1.465, 95% CI: 1.029～2.088, P=0.034), and cumulative patency rates (OR=1.739, 95% CI: 1.052～2.875, P=0.031). The BBAVF group also had better two-year primary (OR=2.140, 95% CI: 1.469～3.118, P＜0.001), assisted (OR=2.529, 95% CI: 1.789～3.575, P＜0.001), secondary (OR=1.748, 95% CI: 1.371～2.229, P＜0.001), and cumulative patency rates (OR=2.002, 95% CI: 1.234～3.249, P=0.005). Regarding complications, the AVG group had a higher risk of postoperative infection (OR=0.207,  95% CI: 0.128～0.334, P＜0.001), thrombosis (OR=0.285, 95% CI: 0.207～0.392, P＜0.001), and steal syndrome (OR=0.628, 95% CI: 0.396～0.996, P=0.048), while the BBAVF group had a higher risk of bleeding (OR=2.725, 95% CI: 1.549～4.793, P=0.001). There were no significant differences between the two groups in the incidence of aneurysm (OR=0.849, 95% CI: 0.457～1.577, P=0.605), anastomotic stenosis (OR=0.471, 95% CI: 0.133～1.666, P=0.243), or overall complications (OR=0.924, 95% CI: 0.502～1.701, P=0.799).  Conclusion  BBAVF is superior in terms of patency rate and control of infection and thrombosis, and is recommended as the first choice for patients with good vascular conditions. AVG is more suitable for urgent dialysis or for patients with poor vascular conditions.

Key words: End-stage renal disease, Dialysis, Vascular access, Brachiobasilic arteriovenous fistula, Arteriovenous graft