The optimal choice of vascular access for dialysis—arteriovenous fistula (AVF) or arteriovenous graft (AVG)—remains controversial. US researchers discovered that a strategy in which AVF was chosen only when there was no increased risk of vascular access failure resulted in fewer interventions and lower costs.
The researchers conducted a pragmatic observational study of 692 patients who started dialysis with a central venous catheter (CVC) and subsequently received an AVF or AVG. In the study they compared two strategies for choosing vascular access. In Period 1 of 2004-2012, a less selective strategy was applied where construction of AVFs was maximized (n=408) and in Period 2 of 2013-2019 a more selective strategy was applied where AVF construction was avoided when there was a high risk of AVF failure (n= 284).
Analyzes showed that AVG was significantly more developed in the second period (41%) than in the first period (28%). The number of vascular access procedures (per 100 patient-years) was higher in period 1 among patients with AVF compared with AVG, but in period 2 the number of procedures was lower with AVF. In addition, average annual costs for vascular access management in Period 1 were significantly higher with AVF ($10,642) compared with average AVG ($6,810), whereas costs in Period 2 were lower ($5,481 vs. $8,253 USD). For all patients together, average total costs per year were significantly lower in period 2 ($6757) than in period 1 ($9781). These results suggest that clinicians should be more selective in creating AVFs.
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