Thrombectomy procedures on AVFs are associated with lower success rate compared to AVGs. In addition to requiring significantly more time and supplies, AVF thrombectomy require significantly greater skill and entail a greater degree of difficulty than procedures on AVGs.
Thrombectomy reimbursement CPT has recently been reviewed by CMS for adjustment but no differentiation is made between AVG or AVF declot.
The study below reveals that the time required and the supplies expended to salvage a thrombosed AVF is significantly greater than that required for an AVG
Expenditures on dialysis vascular access now exceed $2.5 Billion annually in the US. Studies suggest that significant savings could be achieved by increasing arteriovenous fistula (AVF) prevalence to >65%. It is common but unsubstantiated opinion that AVF have lower maintenance costs than arteriovenous grafts (AVG). This manuscript tests this hypothesis by direct comparison. Equipment utilization time and supply utilization on 110 thrombectomy procedures on AVF and 258 on AVG were compared. Procedures techniques were standardized within one facility and procedures performed by a multiplebut limited number of operators. There were no significant differences in demographic variables and comorbid factors between groups. Time to complete AVF thrombectomy was 1.7 times that for AVG. In addition, major supplies used such as wires and balloons were also significantly greater. Interventionists who took longer than average to thrombectomize AVF took longer than average to thrombectomize AVG. The prevalence of arterial inflow lesions was 1.5 greater in thrombosed AVF versus Thrombosed AVG. Procedure costs when analyzed in terms of procedure time, room utilization, staff, and equipment are significantly greater for thrombosed AVF than thrombosed AVG.
1. What is your center experience with resources required for AVG vs AVF declot?