Treatment of failing arterio‑venous dialysis graft by angioplasty, stent, and stent graft: Two‑years analysis of patency rates and cost‑effectiveness

  • Authors:
    • Jan Kavan
    • Jaroslav Kudlicka
    • Jan Malik
    • Eva Chytilova
    • Lukas Lambert
    • Marcela Slavikova
    • Patrik Matras
    • Andrea Burgetova
  • View Affiliations

  • Published online on: September 25, 2019     https://doi.org/10.3892/etm.2019.8050
  • Pages: 4144-4150
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Abstract

The objective of this prospective randomized single‑center study was to compare primary and secondary patency rates, number of percutaneous transluminal angioplasty (PTA) interventions and cost‑effectiveness among PTA, deployment of a stent, or a stent graft in the treatment of failing arteriovenous dialysis grafts (AVG) due to restenosis in the venous anastomosis or the outflow vein. Altogether 60 patients with failing AVG and restenosis in the venous anastomosis or the outflow vein were randomly assigned to either PTA, placement of a stent (E‑Luminexx®) or stent graft (Fluency Plus®). After the procedure, patients with stent or stent graft received dual antiplatelet therapy for the next three months. Follow‑up angiography was scheduled at 3, 6, and 12 months unless requested earlier due to suspected stenosis or malfunction of the access. Subsequently, angiography was performed only if requested by the clinician. During a median follow‑up of 22.4 (IQR=5.7) months patients with PTA, stent, or stent graft required 3.1±1.7, 2.5±1.7, or 1.7±2.1 (P=0.031) secondary PTA interventions. The primary patency rates were 0, 18 and 65% at 12 months and 0, 18 and 37% at 24 months in the PTA, stent, and stent graft group respectively (P<0.0001). The cost of the procedures in the first two years was €7,900±€3,300 in the PTA group, €8,500±€4,500 in the stent group, and €7,500±€6,200 in the stent graft group (P=0.45). We conclude that the treatment of failing dialysis vascular access by the deployment of a stent graft significantly improves its primary patency rates and decreases the number of secondary PTA interventions; however, the reduction in costs for maintaining AVG patency is not significant.
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November-2019
Volume 18 Issue 5

Print ISSN: 1792-0981
Online ISSN:1792-1015

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Spandidos Publications style
Kavan J, Kudlicka J, Malik J, Chytilova E, Lambert L, Slavikova M, Matras P and Burgetova A: Treatment of failing arterio‑venous dialysis graft by angioplasty, stent, and stent graft: Two‑years analysis of patency rates and cost‑effectiveness. Exp Ther Med 18: 4144-4150, 2019
APA
Kavan, J., Kudlicka, J., Malik, J., Chytilova, E., Lambert, L., Slavikova, M. ... Burgetova, A. (2019). Treatment of failing arterio‑venous dialysis graft by angioplasty, stent, and stent graft: Two‑years analysis of patency rates and cost‑effectiveness. Experimental and Therapeutic Medicine, 18, 4144-4150. https://doi.org/10.3892/etm.2019.8050
MLA
Kavan, J., Kudlicka, J., Malik, J., Chytilova, E., Lambert, L., Slavikova, M., Matras, P., Burgetova, A."Treatment of failing arterio‑venous dialysis graft by angioplasty, stent, and stent graft: Two‑years analysis of patency rates and cost‑effectiveness". Experimental and Therapeutic Medicine 18.5 (2019): 4144-4150.
Chicago
Kavan, J., Kudlicka, J., Malik, J., Chytilova, E., Lambert, L., Slavikova, M., Matras, P., Burgetova, A."Treatment of failing arterio‑venous dialysis graft by angioplasty, stent, and stent graft: Two‑years analysis of patency rates and cost‑effectiveness". Experimental and Therapeutic Medicine 18, no. 5 (2019): 4144-4150. https://doi.org/10.3892/etm.2019.8050