title: A comparison of efficacy of endovascular versus surgical repair for the treatment of arteriovenous fistula stenosis in Taiwan.
abstract: BACKGROUND
  Percutaneous transluminal angioplasty (PTA) and fistula reconstruction surgery are therapeutic options for vascular access occlusion in hemodialysis patients. However, owing to its convenience, PTA has gradually become the preferred therapeutic option for fistula stenosis or occlusion. This study investigated the effects of the two therapeutic methods on the vascular access maintenance duration (number of days) and maintenance costs of fistula in dialysis patients from different dialysis units.
  
  
  METHODS
  In this study, 544 hemodialysis patients from 2 dialysis units in a teaching hospital in the southern area of Taiwan were included in the analysis of the frequency of PTA or revascularization surgery and the use of related medical resources by conducting a retrospective chart review.
  
  
  RESULTS
  The frequency of PTA in the patients undergoing long-term hemodialysis was not significantly associated with their demographic characteristics. The efficacy of PTA has declined with shorter maintenance duration with increasing PTA frequency. The cost profile of PTA was more expensive than that of fistula revascularization surgery.
  
  
  CONCLUSIONS
  In this study, PTA was found to be just a temporary solution for fistula thrombosis, whereas fistula reconstruction surgery is inexpensive and improves survival time. Therefore, dialysis units should establish an appropriate standard of care to avoid over-reliance on PTA in order to reduce the fistula failure rate, improve the dialysis efficacy, and reduce the psychological stress in patients, as well as to reduce the maintenance costs and rationalize the medical expenses.
authors.affiliation: Department of Medical Research, Ping-Tung Christian Hospital, Ping-Tung - Taiwan.
authors.forename: Szu-Shan
authors.initials: SS
authors.lastname: Fan
authors.affiliation: Department of Medical Research, Ping-Tung Christian Hospital, Ping-Tung - Taiwan.
authors.forename: Chien-Wen
authors.initials: CW
authors.lastname: Chen
authors.affiliation: School of Medicine, Fu Jen Catholic University, New Taipei City - Taiwan.
authors.forename: Kuo-Cheng
authors.initials: KC
authors.lastname: Lu
authors.affiliation: Department of Medical Research, Ping-Tung Christian Hospital, Ping-Tung - Taiwan.
authors.forename: Hung-Chung
authors.initials: HC
authors.lastname: Mao
authors.affiliation: Department of Medical Research, Ping-Tung Christian Hospital, Ping-Tung - Taiwan.
authors.forename: Miao-Pei
authors.initials: MP
authors.lastname: Chen
authors.affiliation: Department of Medical Research, Ping-Tung Christian Hospital, Ping-Tung - Taiwan.|School of Medicine, Fu Jen Catholic University, New Taipei City - Taiwan.|Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei - Taiwan.
authors.forename: Chu-Lin
authors.initials: CL
authors.lastname: Chou
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000191:economics; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects* / Q000191:economics; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation; D003362:Cost-Benefit Analysis; D005260:Female; D006083:Graft Occlusion, Vascular / Q000191:economics / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D017721:Hospital Costs; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D013624:Taiwan; D013927:Thrombosis / Q000191:economics / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency