Endovascular Treatment of Thrombosed Dialysis Fistulae: A Cumulative Cost Analysis

Objectives: In the present study, we determined the cumulative costs and outcomes of endovascular treatment of thrombosed autogenous arteriovenous fistulae (AVF) at our medical center. Background: Previous studies examining the salvage procedures of thrombosed AVFs have focused exclusively on clinical outcomes, and, in the absence of costing data, current guidelines do not take into consideration economic issues. Methods: A retrospective cohort study was performed among local hemodialysis patients with completely thrombosed AVFs receiving endovascular treatment in our institution between January 1 and December 31, 2008. Forty-four patients were enrolled and followed-up for 1 year. Success and complications were recorded according to consensus definitions, and a comprehensive measurement of total vascular access care-related costs was obtained. Costs are reported in 2010 in U. S. dollars. Results: Clinical success was achieved in 95% of cases. The primary and secondary patency rates were 63 and 78% at 1 year, respectively. Primary patency rate at 12 months was significantly better for radiocephalic AVFs (70% vs. 43%; P = 0.047). The mean cumulative cost of all vascular access care during year 1 was $2,504 (median $1,484; range, $1,362-$18,279; Table V) per patient-year at risk. The mean cumulative cost for maintaining radiocephalic and brachiocephalic AVFs was $1,624 (median $1,381; range, $1,130-$3,116) and $3,578 (median $2,092; range, $1,470-$18,279) per patient-year at risk, respectively (P = 0.022). Conclusion: The cost of maintenance of a thrombosed AVF by endovascular intervention is high, with patients with clotted radiocephalic fistulae incurring the lowest costs and achieving higher survival times. (C) 2011 Wiley-Liss, Inc.