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Routine Clinic Surveillance on Arteriovenous Graft Patency in Hemodialysis Patients with Previous Access

Cheng-Chieh Yen1, Hung-Pin Tu2, Tzu-Chen Lin3,4

  • 1Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan.

International Journal of Medical Sciences
|March 3, 2025
PubMed

Insights

Routine surveillance for arteriovenous grafts (AVGs) in hemodialysis patients increases interventions like stenting and angioplasty, raising costs without improving graft patency. Further cost-effectiveness studies are needed for AVG monitoring.

Area of Science:

  • Nephrology
  • Vascular Surgery
  • Health Economics

Background:

  • Arteriovenous grafts (AVGs) serve as crucial hemodialysis (HD) access for patients with vascular challenges.
  • The efficacy of routine surveillance for maintaining AVG function remains under investigation.
  • This study evaluates clinical and economic impacts of routine surveillance in HD patients with prior access issues.

Purpose of the Study:

  • To assess the clinical outcomes of routine surveillance for arteriovenous grafts (AVGs) in hemodialysis patients.
  • To determine the economic impact of routine surveillance on AVG maintenance and interventions.
  • To compare intervention rates and secondary patency between surveillance and non-surveillance groups.

Main Methods:

  • A cohort study comparing hemodialysis patients with and without routine AVG surveillance.
  • Data collected from the initiation of a collaborative clinic in 2020.
  • Primary outcomes included arteriovenous access reconstruction, graft-anastomosis stenting, and percutaneous transluminal angioplasty (PTA); secondary outcomes were AVG patency and intervention costs.

Main Results:

  • Routine surveillance led to significantly higher rates of graft-anastomosis stenting (0.66 vs. 0.2 per 100 patient-months) and PTA (30.19 vs. 14.17 per 100 patient-months).
  • No significant difference was found in arteriovenous access reconstruction rates (0.46 vs. 0.5 per 100 patient-months) or secondary patency (HR: 0.83).
  • Total AVG intervention costs were more than double in the surveillance group (110,672 NTD vs. 51,874 NTD).

Conclusions:

  • Routine clinic surveillance for AVGs in hemodialysis patients with prior complications increases specific interventions and associated costs.
  • Surveillance did not significantly improve arteriovenous access reconstruction rates or secondary patency.
  • Further research is warranted to evaluate the cost-effectiveness of routine AVG monitoring strategies.

Keywords:
arteriovenous graftoutcomesroutine surveillance

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