Endovascular treatment of thrombosed dialysis fistulae: a cumulative cost analysis.

OBJECTIVES: In the present study, we determined the cumulative costs and outcomes of endovascular treatment of thrombosed autogenous arteriovenous fistulae (AVF) at our medical center. BACKGROUND: Previous studies examining the salvage procedures of thrombosed AVFs have focused exclusively on clinical outcomes, and, in the absence of costing data, current guidelines do not take into consideration economic issues. METHODS: A retrospective cohort study was performed among local hemodialysis patients with completely thrombosed AVFs receiving endovascular treatment in our institution between January 1 and December 31, 2008. Forty-four patients were enrolled and followed-up for 1 year. Success and complications were recorded according to consensus definitions, and a comprehensive measurement of total vascular access care-related costs was obtained. Costs are reported in 2010 in U.S. dollars. RESULTS: Clinical success was achieved in 95% of cases. The primary and secondary patency rates were 63 and 78% at 1 year, respectively. Primary patency rate at 12 months was significantly better for radiocephalic AVFs (70% vs. 43%; P = 0.047). The mean cumulative cost of all vascular access care during year 1 was $2,504 (median $1,484; range, $1,362-$18,279; Table V) per patient-year at risk. The mean cumulative cost for maintaining radiocephalic and brachiocephalic AVFs was $1,624 (median $1,381; range, $1,130-$3,116) and $3,578 (median $2,092; range, $1,470-$18,279) per patient-year at risk, respectively (P = 0.022). CONCLUSION: The cost of maintenance of a thrombosed AVF by endovascular intervention is high, with patients with clotted radiocephalic fistulae incurring the lowest costs and achieving higher survival times.

Percutaneous treatment of thrombosed arteriovenous fistulas: clinical and economic implications.

BACKGROUND AND OBJECTIVES: Maintenance of previously thrombosed arteriovenous fistulas (AVFs) as functional vascular accesses can be highly expensive, with relevant financial implications for healthcare systems. The aim of our study was to evaluate the costs and health outcomes of vascular access care in hemodialysis patients with AVF thrombosis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A retrospective, controlled cohort study was performed among local hemodialysis patients with completely thrombosed AVFs between August 1, 2007, and July 1, 2008. Detailed clinical and demographic information was collected and a comprehensive measure of total vascular access costs was obtained. Costs are reported in 2009 U.S. dollars. RESULTS: A total of 63 consecutive hemodialysis patients with thrombosed AVFs were identified--a cohort of 37 patients treated with percutaneous thrombectomy and a historic cohort of 25 patients with abandoned thrombosed AVFs. The mean cost of all vascular access care at 6 months was $2479. Salvage of thrombosed AVFs led to a near two-fold reduction in access-related expenses, per patient-month at risk ($375 versus $706; P = 0.048). The costs for access-related hospitalizations ($393 versus $91; P = 0.050), management of access dysfunction ($106 versus $28; P = 0.005), and surgical interventions ($35 versus $6; P = 0.001) were also significantly lower in the percutaneous treatment group. At 6 months, most of these patients had a functional AVF as permanent vascular access (91% versus 33%, P = 0.0001). CONCLUSIONS: Salvage of thrombosed AVF is a highly efficient procedure; therefore, intensive efforts should be undertaken to universalize these interventions.