Thrombolysis versus surgical thrombectomy for the treatment of dialysis graft thrombosis: pilot study comparing costs.
OBJECTIVE
This preliminary investigation was designed to compare the cost of pharmacomechanical thrombolysis and angioplasty with that of surgical thrombectomy for the treatment of thrombosed hemodialysis grafts.


METHODS
This prospective, randomized study consisted of 20 patients with unrevised, polytetrafluoroethylene forearm dialysis grafts of similar configuration in which graft thrombosis occurred for the first time. Ten patients underwent pulse-spray thrombolysis plus angioplasty, and 10 patients underwent surgical thrombectomy. The technical costs, professional fees, and all other associated costs were obtained. Procedural data, graft patency rates, and demographic information were analyzed.


RESULTS
The technical success rate was 70% for thrombolysis and 80% for surgical thrombectomy. The duration of patency, including the technical failures, was 81.6 days for thrombolysis and 93.9 days for surgery. For the thrombolysis and angioplasty procedure, the median technical cost was $2,906 and the medial professional fee was $3,156 for a medial total cost of $6,062. The median technical cost for surgical thrombectomy was $2,449 and the median surgical fee was $2,100, but these patients incurred an additional anesthesia fee (median, $1,031) bringing the total median cost to $5,580.


CONCLUSIONS
These two competing procedures were comparable in cost, and the technical success and patency rates were also similar.
Vesely
T M
TM
Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA.
Idso
M C
MC
Audrain
J
J
Windus
D W
DW
Lowell
J A
JA
D000328:Adult; D000368:Aged; D000800:Angioplasty, Balloon / Q000191:economics; D001166:Arteriovenous Shunt, Surgical / Q000295:instrumentation; D002408:Catheters, Indwelling; D005251:Fees, Medical; D005260:Female; D005542:Forearm / Q000098:blood supply*; D006083:Graft Occlusion, Vascular / Q000601:surgery / Q000628:therapy; D017048:Health Care Costs; D006801:Humans; D008297:Male; D013677:Medical Laboratory Science / Q000191:economics; D008875:Middle Aged; D010865:Pilot Projects; D011138:Polytetrafluoroethylene; D011446:Prospective Studies; D006435:Renal Dialysis / Q000295:instrumentation*; D017131:Thrombectomy / Q000191:economics*; D015912:Thrombolytic Therapy / Q000191:economics*; D013927:Thrombosis / Q000188:drug therapy* / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
D011138:Polytetrafluoroethylene