Document Detail


Balloon angioplasty for arteriovenous graft stenosis.
MedLine Citation:
PMID:  11357977     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To retrospectively review the long-term outcome as well as the cost effectiveness of thrombolytic therapy and balloon angioplasty (TBA) versus surgical thrombectomy and balloon angioplasty (SBA) in the treatment of prosthetic dialysis access grafts. METHODS: Between February 1996 and February 1999, 63 hemodialysis patients (35 women; mean age 62.2 years) were treated for 105 thromboses in 6-mm polytetrafluoroethylene straight or loop bridge arteriovenous grafts. Choice of treatment was at the discretion of the surgeon or interventional radiologist: either Fogarty balloon thrombectomy followed by balloon dilation of the venous anastomotic stenosis or urokinase thrombolysis followed by angioplasty. RESULTS: Forty-eight SBAs and 55 TBAs were performed in 63 patients without complications. The primary patency rates in the entire cohort were 34%, 29%, and 17% at 1, 2, and 3 months, respectively. Primary patency after TBA was 29%, 18%, and 11%, and that for SBA, 45%, 45%, and 33% over the same time intervals. The mean graft survival was 10 days for TBA versus 31 days for SBA. Repeat angioplasty performed in 23 grafts produced secondary patency rates of 52% at 1 month, 34% at 3 months, and 5% at 5 months. The Medicare reimbursement for both treatments was identical ($1638 for TBA and $1670 for SBA). CONCLUSIONS: The poor patency rate and high cost of TBA and SBA suggests that these procedures should not be routinely used for salvage of thrombosed arteriovenous grafts with outflow stenosis. Patch angioplasty or creation of simultaneous temporary and new permanent accesses may be a more cost-effective approach in these patients.
Authors:
P Anain; S Shenoy; M O'Brien-Irr; L M Harris; M Dryjski
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists     Volume:  8     ISSN:  1526-6028     ISO Abbreviation:  J. Endovasc. Ther.     Publication Date:  2001 Apr 
Date Detail:
Created Date:  2001-05-18     Completed Date:  2001-10-25     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  100896915     Medline TA:  J Endovasc Ther     Country:  United States    
Other Details:
Languages:  eng     Pagination:  167-72     Citation Subset:  IM    
Affiliation:
Department of Surgery, State University of New York at Buffalo, USA.
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MeSH Terms
Descriptor/Qualifier:
Angioplasty, Balloon* / economics
Arterial Occlusive Diseases / epidemiology,  surgery,  therapy*
Cost-Benefit Analysis
Female
Graft Occlusion, Vascular / epidemiology,  surgery,  therapy*
Humans
Male
Middle Aged
Renal Dialysis
Retrospective Studies
Thrombectomy / economics
Thrombolytic Therapy / economics
Time
Treatment Outcome
United States
Vascular Patency / physiology
Comments/Corrections
Comment In:
J Endovasc Ther. 2001 Apr;8(2):173-6   [PMID:  11357978 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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