Percutaneous treatment of thrombosed arteriovenous fistulas: clinical and economic implications

Abstract

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.

Figure 1.

Percentage of freedom from subsequent interventions at 6 months. The graph shows the primary patency as of enrollment according to the Kaplan–Meier analysis.

Figure 2.

Permanent vascular access type at 6 months of follow-up for each study group. At the end of follow-up, a significantly higher number of group A patients had a functioning AVF as a permanent vascular access.