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

Background

Arteriovenous grafts (AVGs) are an alternative for hemodialysis (HD) access in patients with inadequate vasculature or advanced age. The effect of routine surveillance for AVG maintenance remains unclear. This study assesses the clinical and economic outcomes of routine surveillance at a collaborative clinic in patients with previous access complications.

Methods

We recruited HD patients from the initiation of the clinic in 2020, and divided them into two groups: those receiving routine surveillance and those without. Primary outcomes included AVG interventions (e.g., arteriovenous access [AVA] reconstruction, graft-anastomosis stenting, percutaneous transluminal angioplasty [PTA]). Other outcomes included AVG secondary patency and costs associated with the interventions.

Results

Twenty-two patients with routine surveillance and 65 without were recruited. There was no significant difference in AVA reconstruction rate between the surveillance and non-surveillance groups (0.46 vs. 0.5 per 100 patient-months, p = 0.99), however, rates of graft-anastomosis stenting (0.66 vs. 0.2 per 100 patient-months, p = 0.02) and PTA (30.19 vs. 14.17 per 100 patient-months, p < 0.01) were significantly higher in the surveillance group. No significant difference was observed in secondary patency (hazard ratio: 0.83, p = 0.79). The total costs of AVG interventions were more than double in the surveillance group (110672 New Taiwan Dollar [NTD] vs. 51874 NTD, p < 0.01).

Conclusions

Routine clinic surveillance in HD patients with AVGs and previous access complications resulted in significantly higher rates of graft-anastomosis stenting, PTA, and associated costs, without significant differences in AVA reconstruction rates or secondary patency. These results highlight the need for further assessment of the cost-effectiveness of routine AVG monitoring.