At last a properly conducted RCT on the effectiveness(or not) of stent grafts in Upper arm AVFs. The excluded drug coated balloons.W whether stents would be equivalent to stent grafts at the treated site requires a different study and use of only one agent delivered by the balloon.

For me the issue, is whether the use of the stent graft is cost effective in term of secondary access patency and whether differences in the number of interventions needed till abandonment of the AVF differs.

For CMS, this should be the important factor. In the 1990, total cost of access care consumed about 18% of the total CMS expenditures for ESKD care. I have not been able to find more recent data!. Does anyone know? My suspicion is that it may have gone up. Value based approaches in my mind put the burden on us and the LDOs but the benefits reaped downstream would be huge for CMS.