THROMBOLYSIS VERSUS SURGICAL THROMBECTOMY FOR THE TREATMENT OF DIALYSIS GRAFT THROMBOSIS - PILOT-STUDY COMPARING COSTS

PURPOSE: This preliminary investigation was designed to compare the co st of pharmacomechanical thrombolysis and angioplasty with that of sur gical thrombectomy for the treatment of thrombosed hemodialysis grafts . PATIENTS AND METHODS: This prospective, randomized study consisted o f 20 patients with unrevised, polytetrafluoroethylene forearm dialysis grafts of similar configuration in which graft thrombosis occurred fo r the first time. Ten patients underwent pulse-spray thrombolysis plus angioplasty, and 10 patients underwent surgical thrombectomy. The tec hnical costs, professional fees, and all other associated costs were o btained. Procedural data, graft patency rates, and demographic informa tion were analyzed. RESULTS: The technical success rate was 70% for th rombolysis and 80% for surgical thrombectomy. The duration of patency, including the technical failures, was 81.6 days for thrombolysis and 93.9 days for surgery. For the thrombolysis and angioplasty procedure, the median technical cost was $2,906 and the median professional fee was $3,156 for a median total cost of $6,062. The median technical cos t for surgical thrombectomy was $2,449 and the median surgical fee was $2,100, but these patients incurred an additional anesthesia fee (med ian, $1,031) bringing the total median cost to $5,580. CONCLUSIONS: Th ese two competing procedures were comparable in cost.