Nephrology Research and Development Unit, Hospital S. João, Porto, Portugal.
Clin J Am Soc Nephrol. 2010 Dec;5(12):2245-50. doi: 10.2215/CJN.03070410. Epub 2010 Aug 26.
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.
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).
Salvage of thrombosed AVF is a highly efficient procedure; therefore, intensive efforts should be undertaken to universalize these interventions.
维持先前血栓形成的动静脉瘘（AVF）作为功能性血管通路可能非常昂贵，这对医疗保健系统有重大的财务影响。我们研究的目的是评估血栓形成的 AVF 血液透析患者血管通路护理的成本和健康结果。
设计、设置、参与者和测量：这是一项在 2007 年 8 月 1 日至 2008 年 7 月 1 日期间完全血栓形成的 AVF 的本地血液透析患者中进行的回顾性、对照队列研究。收集了详细的临床和人口统计学信息，并获得了全面的总血管通路成本测量。成本以 2009 年美元报告。
确定了总共 63 例连续血栓形成的 AVF 血液透析患者-一组 37 例接受经皮血栓切除术治疗的患者和一组 25 例放弃血栓形成的 AVF 的历史队列。6 个月时所有血管通路护理的平均成本为 2479 美元。血栓形成的 AVF 挽救导致与通路相关的费用降低近一倍，每患者风险月费用（375 美元对 706 美元；P = 0.048）。经皮治疗组的与通路相关的住院费用（393 美元对 91 美元；P = 0.050）、通路功能障碍的管理费用（106 美元对 28 美元；P = 0.005）和手术干预费用（35 美元对 6 美元；P = 0.001）也明显降低。在 6 个月时，这些患者中的大多数都有功能正常的 AVF 作为永久性血管通路（91%对 33%，P = 0.0001）。
血栓形成的 AVF 挽救是一种非常有效的方法；因此，应努力普及这些干预措施。
