Division of Surgery, Department of Surgery, Rush University Medical Center, Chicago, Ill.
Division of Surgery, Department of Surgery, Rush University Medical Center, Chicago, Ill.
J Vasc Surg. 2021 Jun;73(6):2098-2104. doi: 10.1016/j.jvs.2020.10.076. Epub 2020 Nov 27.
Techniques such as the use of nonpenetrating vascular clips for arteriovenous fistula (AVF) anastomotic creation have been developed in an effort to reduce fistula-related complications. However, the outcomes data for the use of clips have remained equivocal, and the cost evaluations to support their use have been largely theoretical. Therefore, the present study aimed to determine both the clinical and the cost outcomes of AVFs created with nonpenetrating vascular clips compared with the continuous suture technique during a 10-year period at a single institution.
All patients undergoing AVF creation in the upper extremity from 2009 through 2018 were retrospectively analyzed. The patient demographics and AVF outcomes were collected and compared stratified by the surgical technique used. A cost analysis was performed of a subgroup of patients from 2013 to 2018.
During the 10-year study period, 916 AVFs were created (79% using the continuous suture technique and 21% using nonpenetrating vascular clips). Patient demographics and comorbid conditions did not differ between the two groups, and no differences were present in maturation, primary patency, assisted primary patency, or complication rates between the two groups at 1 year. The suture group had a shorter time to maturation (4.3 months vs 5.5 months; P < .01) and improved secondary patency compared with the clip group (77.13% vs 69.59%; P = .03) The cost analysis of the procedures revealed a significant difference in direct costs (suture, $1389.26 vs clip, $1716.51; P < .01) and contribution margin (suture, $1770.19 vs clip, $1128.36; P < .01) for the two groups.
Both suture and clip techniques in AVF creation demonstrated equivalent rates of maturation, primary patency, assisted primary patency, and complications at 1 year with higher expense associated with the use of clips. Thus, in an effort to reduce the economic burden of healthcare in the United States, the findings from the present study support the preferential use of the standard polypropylene suture technique when creating upper extremity AVFs.
为了降低动静脉瘘（AVF）相关并发症，开发了使用非穿透性血管夹进行动静脉吻合术等技术。然而，使用夹的结果数据仍然存在争议，并且支持其使用的成本评估在很大程度上是理论上的。因此，本研究旨在确定在单一机构的 10 年内，与连续缝合技术相比，使用非穿透性血管夹创建 AVF 的临床和成本结果。
回顾性分析了 2009 年至 2018 年间在上肢进行 AVF 手术的所有患者。收集并比较了患者人口统计学数据和 AVF 结果，并按使用的手术技术进行分层。对 2013 年至 2018 年的亚组患者进行成本分析。
在 10 年的研究期间，共创建了 916 个 AVF（79%使用连续缝合技术，21%使用非穿透性血管夹）。两组患者的人口统计学和合并症无差异，两组在 1 年内的成熟度、原发性通畅率、辅助原发性通畅率或并发症发生率方面也无差异。缝合组的成熟时间更短（4.3 个月比 5.5 个月；P <.01），与夹组相比，继发性通畅率也有所提高（77.13%比 69.59%；P =.03）。手术过程的成本分析显示，两组的直接成本（缝合，$1389.26 与夹，$1716.51；P <.01）和边际贡献（缝合，$1770.19 与夹，$1128.36；P <.01）有显著差异。
在 1 年内，AVF 手术中缝合和夹技术的成熟度、原发性通畅率、辅助原发性通畅率和并发症发生率相当，但夹的使用费用更高。因此，为了减轻美国医疗保健的经济负担，本研究的结果支持在创建上肢 AVF 时优先使用标准的聚丙烯缝线技术。
