The Benefits and Cost-Effectiveness of Arteriovenous (AV) Fistula Screening in Haemodialysis Patients

• Published in: Curēus (Palo Alto, CA) CA), 2023-12, Vol.15 (12), p.e50185-e50185
• Main Authors: Elshikhawoda, Mohamed S M, Jararaa, Sohaib, Okaz, Mahmoud, Houso, Mohammed S M, Maraqa, Abdelrahman, Abdallah, Reyad, Kenu, Eyitomi Terry, Mohamed, Hussam Khougali, Shekoni, Oluwatobi, Papp, Laszlo
• Format: Article
• Language: English
• Subjects: Cardiac/Thoracic/Vascular Surgery; Catheters; Diabetes; Fistula; Hemodialysis; Hypertension; Kidney diseases; Patients; Pseudoaneurysm; Surveillance; Thrombosis; Ultrasonic imaging; Veins & arteries; Venous access
• ISSN: 2168-8184; 2168-8184
• DOI: 10.7759/cureus.50185

Background Ultrasound (US) monitoring of arteriovenous fistulas (AVFs) presents contradictory findings. These differences may be attributed to variances in the chosen surveillance strategy, the specific type of fistula being monitored, and the precise technique used for ultrasound scanning. In this study, we are trying to assess the benefits and cost-effectiveness of US scanning of AVF. Patients and methods This was a descriptive, retrospective, and observational study. The study sample consisted of patients diagnosed with end-stage renal disease (ESRD) on hemodialysis who had AVF for dialysis either by native vein or using prosthetic grafts. We excluded all the patients whose fistula failed to mature, failed to attend the surveillance scan at six weeks, or had absent records or incomplete data. We retrieved the data of the patients who underwent AVF creation at Glan Clwyd Hospital between April 2020 and April 2023. The data was analysed using statistical software (SPSS) version 21 (IBM Corp., Armonk, NY, USA). Results Ninety-eight patients were studied. Stenosis 43.9% (n = 43) was the predominant complication, followed by thrombosis (15.3%; n = 15) while the remaining complications (bleeding, pseudoaneurysm) were less prominent. On the other hand, a total of 37.8% (n = 37) did not experience any complications. Primary patency ranged from 2 to 87 months with a mean of 9 ± 13.2 months SD, and secondary patency ranged from 1 to 24 months with a mean of 1.3 ± 3.9 months SD. The mean cost of a surveillance scan for AVF is 2520 USD, and the mean cost of intervention is 1332 + 1258 USD SD. Out of all the patients, 52 (53%) underwent intervention to salvage the AVF, 2 (2%) received open surgical intervention, and 50 (51%) underwent endovascular intervention. Considering the AVF failure to work, 29.6% (n = 29) had fistulas that failed to work, and 70.4% (n = 69) were still working. Conclusion Routine duplex scanning in six-month periods to diagnose failing AV fistulas is not cost-effective when compared to diagnosing failing or failed AV fistulas based on clinical symptoms.