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Hemodialysis graft salvage
D N Brotman1, L Fandos, G R Faust
1Department of Surgery, Long Island Jewish Medical Center, New Hyde Park, New York.
Journal of the American College of Surgeons
|May 1, 1994
Summary
Salvaging thrombosed polytetrafluoroethylene (PTFE) hemodialysis grafts offers poor long-term patency, especially with thrombectomy alone. New graft placement may be more cost-effective than salvage attempts.
Area of Science:
- Vascular Surgery
- Nephrology
- Graft Patency
Background:
- Hemodialysis access procedures are common surgical treatments.
- Salvage procedures aim to extend the lifespan of thrombosed grafts.
- Cost-effectiveness of salvage procedures is crucial amid medical cost containment.
Purpose of the Study:
- To evaluate the success and cost-effectiveness of salvage procedures for thrombosed upper extremity polytetrafluoroethylene (PTFE) hemodialysis grafts.
- To determine if patient factors predict graft patency after salvage.
Main Methods:
- Retrospective analysis of 116 thrombectomies or revisions in 70 patients with PTFE hemodialysis graft thrombosis.
- Life-table analysis to assess graft patency over time.
- Cost analysis of salvage procedures.
Main Results:
- Graft patency rates were low: 2.5% at one year.
- Revised grafts showed higher patency (59% at 30 days, 25% at 120 days) than thrombectomized grafts (30% at 30 days, 10% at 120 days).
- Average cost per salvage attempt was $4,350; no patient factors predicted patency.
Conclusions:
- Salvage patency for PTFE dialysis grafts is poor, particularly with thrombectomy alone.
- Graft revision also yields suboptimal results.
- Placing a new graft may be the most effective and cost-efficient strategy over salvage.