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


METHODS
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.
Coentrão
Luís
L
Nephrology Research and Development Unit, Hospital S. João, Porto, Portugal. coentrao@med.up.pt
Bizarro
Pedro
P
Ribeiro
Carlos
C
Neto
Ricardo
R
Pestana
Manuel
M
D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects* / Q000191:economics; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects; D012189:Retrospective Studies; D013927:Thrombosis / Q000628:therapy*
Clin J Am Soc Nephrol. 2007 Sep;2(5):1043-53
17702726
Semin Dial. 2007 Sep-Oct;20(5):459-64
17897255
J Vasc Surg. 2002 Mar;35(3):603-10
11877717
Adv Chronic Kidney Dis. 2009 Sep;16(5):339-51
19695502
Catheter Cardiovasc Interv. 2010 Jan 1;75(1):14-21
19862805
J Chronic Dis. 1987;40(5):373-83
3558716
Am J Kidney Dis. 2005 Sep;46(3):501-8
16129212
J Vasc Surg. 2009 Oct;50(4):953-6
19786244
Nephrol Dial Transplant. 2008 Nov;23(11):3578-84
18511608
Semin Dial. 2008 Nov-Dec;21(6):581-3
19000116
Am J Kidney Dis. 2002 Sep;40(3):611-22
12200814
J Vasc Interv Radiol. 2002 Dec;13(12):1211-8
12471184
Kidney Int. 2000 Mar;57(3):1169-75
10720969
J Vasc Interv Radiol. 2005 Dec;16(12):1605-11
16371525
J Vasc Interv Radiol. 1997 Sep-Oct;8(5):813-24
9314373
J Am Soc Nephrol. 2005 Jan;16(1):201-9
15563567
Kidney Int. 2004 Oct;66(4):1622-32
15458459
Am J Kidney Dis. 2006 Mar;47(3):469-77
16490626
Radiology. 2002 May;223(2):339-44
11997535
Kidney Int. 2000 Mar;57(3):1124-40
10720965