Cost-effectiveness of angiographic surveillance of dialysis access grafts after complete thrombosis

Abstract

Cost-Effectiveness of Angiographic Surveil lance of Dialysis Access Grafts After Complete Thrombosis Navraj S. Grewal, MD, University of Chicago Hospitals, Chicago, IL, George X. Szymski, MD, Brian S. Funaki, MD Purpose: To determine the cost-effectiveness of routine angiographic surveillance of dialysis access grafts between episodes of thrombosis. Mater ia ls /Methods: Over a 1-year period, 50 patients presenting with thrombosis of dialysis access grafts were scheduled for routine angiographic surveillance at 1 month. At the time of surveillance, percutaneous angioplasty of venous and arterial stenoses was performed if necessary. The cost of maintaining graft patency in this group was compared to the cost of maintaining graft patency in patients who did not comply with the surveillance protocol. Most patients were included in both groups since compliance with follow-up visits between episodes of thrombosis was inconsistent. Results: In 50 patients, there were 92 cases of thrombosis after appropriate angiographic follow-up. The average cost of maintaining access of functioning grafts in this group was $3821 per month. In 34 cases of thrombolysis without interval follow-up, the average cost of maintaining graft patency was $5629 per month. The average patency of grafts with routine follow-up was 3.8 months; the average patency of grafts without angiographic follow-up was 2.1 months. Conclusion: Angiographic surveillance of dialysis access grafts after an event of thrombosis is cost effective and improves patency rates. Take H o m e Points: Surveillance via angiography is both cost effective and prolongs the patency of dialysis grafts after thrombolysis.