A randomized controlled trial and cost-effectiveness analysis of early cannulation arteriovenous grafts versus tunneled central venous catheters in patients requiring urgent vascular access for hemodialysis.
J Vasc Surg
; 65(3): 766-774, 2017 Mar.
Article
in En
| MEDLINE
| ID: mdl-28236919
ABSTRACT
OBJECTIVE:
Early cannulation arteriovenous grafts (ecAVGs) are proposed as an alternative to tunneled central venous catheters (TCVCs) in patients requiring immediate vascular access for hemodialysis (HD). We compared bacteremia rates in patients treated with ecAVG and TCVC.METHODS:
The study randomized 121 adult patients requiring urgent vascular access for HD in a 11 fashion to receive an ecAVG with or without (+/-) an arteriovenous fistula (AVF; n = 60) or TCVC+/-AVF (n = 61). Patients were excluded if they had active systemic sepsis, no anatomically suitable vessels, or an anticipated life expectancy <3 months. The primary end point was the culture-proven bacteremia rate at 6 months, with the trial powered to detect a reduction in bacteremia from 24% to 5% (α = .05, ß = .8). Secondary end points included thrombosis, reintervention, and mortality. A cost-effectiveness analysis was also performed.RESULTS:
Culture-proven bacteremia developed in 10 patients (16.4%) in the TCVC arm ≤6 months compared with two (3.3%) in the ecAVG+/-AVF arm (risk ratio, 0.2; 95% confidence interval, 0.12-0.56; P = .02). Mortality was also higher in the TCVC+/-AVF cohort (16% [n = 10] vs 5% [n = 3]; risk ratio, 0.3; 95% CI, 0.08-0.45; P = .04). The difference in treatment cost between the two arms was not significant (£11,393 vs £9692; P = .24).CONCLUSIONS:
Compared with TCVC+/-AVF, a strategy of ecAVG+/-AVF reduced the rate of culture-proven bacteremia and mortality in patients requiring urgent vascular access for HD. The strategy also proved to be cost-neutral.
Full text:
1
Collection:
01-internacional
Topics:
Promover_ampliacao_atencao_especializada
Health context:
1_ASSA2030
/
4_TD
Database:
MEDLINE
Main subject:
Blood Vessel Prosthesis
/
Catheterization, Central Venous
/
Catheterization
/
Catheters, Indwelling
/
Renal Dialysis
/
Health Care Costs
/
Blood Vessel Prosthesis Implantation
/
Central Venous Catheters
Type of study:
Clinical_trials
/
Diagnostic_studies
/
Etiology_studies
/
Health_economic_evaluation
/
Observational_studies
/
Risk_factors_studies
Country/Region as subject:
Europa
Language:
En
Journal:
J Vasc Surg
Year:
2017
Document type:
Article