Hemodialysis graft salvage.
Hemodialysis access procedures account for a large percentage of patients undergoing surgical treatment. Salvage procedures are frequently used to extend the life of a thrombosed graft and thereby maximize the limited available access sites. Factors that may influence the success of salvage procedures, as well as the financial risk to benefit comparison, may be of increasing importance in the era of aggressive medical cost containment. The charts of 70 patients who underwent 116 thrombectomies or revisions of polytetrafluoroethylene (PTFE) hemodialysis arteriovenous grafts of the upper extremity for thrombosis were retrospectively analyzed. Patency of salvaged grafts by life-table analysis was 75.0 percent at two days, 45.0 percent at 30 days, 18.0 percent at 120 days and 2.5 percent at one year. Patency was 59 and 25 percent for revised grafts at 30 and 120 days, respectively, versus 30 and 10 percent at the same time intervals for thrombectomized grafts only. Minimum combined operative and hospital costs were $4,350 per salvage attempt. Salvage patency of PTFE dialysis grafts of the upper extremity was dismal, especially when thrombectomy alone was used. No specific patient factors were predictive of patency interval. Based upon these results, we cannot continue to recommend graft thrombectomy alone for thrombosed dialysis grafts. Because the poor results with graft revision as well, placement of a new graft without any attempt at salvage may be the best therapeutic and cost-effective option.
Brotman
D N
DN
Department of Surgery, Long Island Jewish Medical Center, New Hyde Park, New York.
Fandos
L
L
Faust
G R
GR
Doscher
W
W
Cohen
J R
JR
D000328:Adult; D005260:Female; D006083:Graft Occlusion, Vascular / Q000191:economics / Q000601:surgery*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D006435:Renal Dialysis / Q000009:adverse effects / Q000191:economics / Q000379:methods; D012189:Retrospective Studies
D011138:Polytetrafluoroethylene