Mohr Belinda A, Sheen Antoinette L, Roy-Chaudhury Prabir, Schultz Scott R, Aruny John E
W. L. Gore & Associates Inc, 2205 West Whispering Wind Drive, Phoenix, AZ 85085.
Curis Consulting LLC, Phoenix, Arizona.
J Vasc Interv Radiol. 2019 Feb;30(2):203-211.e4. doi: 10.1016/j.jvir.2018.12.006.
To compare reinterventions and associated costs to maintain arteriovenous graft hemodialysis access circuits after rescue with percutaneous transluminal angioplasty (PTA), with or without concurrent Viabahn stent grafts, over 24 months.
This multicenter (n = 30 sites) study evaluated reintervention number, type, and cost in 269 patients randomized to undergo placement of stent grafts or PTA alone. Outcomes were 24-month average cumulative number of reinterventions, associated costs, and total costs for all patients and in 4 groups based on index treatment and clinical presentation (thrombosed or dysfunctional).
Over 24 months, the patients in the stent graft arm had a 27% significant reduction in the average number of reinterventions within the circuit compared to the PTA arm (3.7 stent graft vs 5.1 PTA; P = .005) and similar total costs ($27,483 vs $28,664; P = .49). In thrombosed grafts, stent grafts significantly reduced the number of reinterventions (3.7 stent graft vs 6.2 PTA; P = .022) and had significantly lower total costs compared to the PTA arm ($30,329 vs $37,206; P = .027). In dysfunctional grafts, no statistical difference was observed in the number of reinterventions or total costs (3.7 stent graft vs 4.4 PTA; P = .12, and $25,421 stent graft and $22,610 PTA; P = .14).
Over 24 months, the use of stent grafts significantly reduced the number of reinterventions for all patients, driven by patients presenting with thrombosed grafts. Compared to PTA, stent grafts reduced overall treatment costs for patients presenting with thrombosed grafts and had similar costs for stenotic grafts.
比较经皮腔内血管成形术（PTA）单独治疗或联合使用Viabahn覆膜支架对动静脉移植血管进行抢救后，在24个月内维持动静脉移植血管血液透析通路所需的再次干预措施及相关费用。
这项多中心（n = 30个地点）研究评估了269例随机接受覆膜支架植入或单纯PTA治疗的患者的再次干预次数、类型和费用。结局指标为所有患者以及根据初始治疗和临床表现（血栓形成或功能障碍）划分的4组患者24个月的平均累计再次干预次数、相关费用和总费用。
在24个月内，与PTA组相比，覆膜支架组患者移植血管通路的平均再次干预次数显著减少27%（覆膜支架组为3.7次，PTA组为5.1次；P = 0.005），且总费用相似（27,483美元对28,664美元；P = 0.49）。在血栓形成的移植血管中，覆膜支架显著减少了再次干预次数（覆膜支架组为3.7次，PTA组为6.2次；P = 0.022），且与PTA组相比总费用显著更低（30,329美元对37,206美元；P = 0.027）。在功能障碍的移植血管中，再次干预次数或总费用未观察到统计学差异（覆膜支架组为3.7次，PTA组为4.4次；P = 0.12，覆膜支架组为25,421美元，PTA组为22,610美元；P = 0.14）。
在24个月内，对于所有患者，尤其是血栓形成的移植血管患者，使用覆膜支架显著减少了再次干预次数。与PTA相比，覆膜支架降低了血栓形成的移植血管患者的总体治疗费用，对于狭窄的移植血管患者费用相似。
