Ces radiol. 2016, 70(2):78-84 | DOI: 10.55095/CesRadiol2016/012

Comparison of one-year patency rate and cost-effectiveness of stent graft vs. stent vs. PTA in dialysis AV graftOriginal article

Jan Kaván¹, Jaroslav Kudlička², Jiří Křivánek¹, Lubomíra Forejtová¹, Patrik Matras¹, Tomáš Padrta¹, Marcela Slavíková³, Lukáš Lambert¹, Jan Malík²

¹ Radiodiagnostická klinika 1. LF UK a VFN, Praha

² III. interní klinika 1. LF UK a VFN, Praha

³ II. chirurgická klinika kardiovaskulární chirurgie 1. LF UK a VFN, Praha

Aim: The aim of our study is to compare mid-term patency and cost-effectiveness of balloon angioplasty and implantation of stent or stent graft in the treatment of hemodialysis arteriovenous graft restenosis.

Methods: Between July 2013 and May 2015, 46 patients (age 67 ± 14 years, 33% males) were randomized into three study arms for treatment of an early recurrent hemodialysis shunt restenosis located in the venous anastomosis of a prosthetic graft or in the outflow vein (index segment). Fourteen patients were treated with balloon angioplasty (PTA), 14 patients with stenting and 18 patients with implantation of a stent-graft. Two patients (one with stent-graft and one with PTA) were excluded because no follow-up angiography was performed in the first three months after the procedure. Primary patency rates of the index segment and the hemodialysis shunt were compared among the groups and patients who completed a twelve month follow-up were included in the cost analysis.

Results: The twelve-month primary patency of the index segment was 0% for PTA group, 29% for stent group and 76% for stent graft group (p < 0.0001). Six-month primary patency of vascular access was 8% for PTA group, 50% for stent group and 47% for stent graft group (p = 0.014). Twelve-month primary patency of vascular access was 0% for PTA group, 14% for stent group and 35% for stent graft group (p = 0.007). The mean number of reinterventions of the index segment was 2,89 by PTA group, 1,64 by stent group and 0,6 by stent graft group. The mean number of all vascular access reinterventions was 6,0 by PTA group, 3,73 by stent group and 2,4 by stent graft group (p = 0.0094). The mean cost for all endovascular interventions during the 12 months follow-up including primary interventions and all reinterventions was 215 054 CZK by PTA group, 182 297 CZK by stent group and 161 934 CZK by stent graft group.

Conclusion: Treatment of an early recurrent hemodialysis shunt restenosis located in the venous anastomosis of a prosthetic graft or in the outflow vein by stent graft implantation results in significantly better primary patency, decreased need for reinterventions, and lower cost of the endovascular treatment in the first year after the primary intervention compared to PTA and stenting.

Keywords: arteriovenous graft, PTA, stenosis, stent, stent graft

Grants and funding:

Práce byla podpořena grantem číslo NT14160-3/2013 Interní grantové agentury Ministerstva zdravotnictví.

Accepted: April 15, 2016; Published: June 1, 2016  Show citation