Purpose: To present our experience, outcomes, and costs of endovascular occlusion for the management of hemodialysis arteriovenous circuits.
Material and Methods: Data from 32 consecutive patients (mean age 64, 13 male, 19 female) who underwent endovascular occlusion of their native arteriovenous fistula (AVF, n=27) or arteriovenous graft (AVG, n=5) between December 2010 and September 2019 were retrospectively reviewed. The reasons for occlusion were bleeding or risk of rupture (n=19), dialysis-associated steal syndrome (n=8), and upper extremity swelling (n=5). Occlusion was performed using coils (n=3), endovascular plugs (n=14), or both (n=14). Costs of inventory used during the procedure were also compared.
Results: Overall endovascular occlusion was technically successful in 31 of 32 patients (97%). Coil embolization was technically successful in 2 of 3 patients (67%), endovascular plug embolization in 14 of 14 patients (100%), and endovascular plug plus coil embolization in 14 of 14 patients (100%). Four patients (13%) required further intervention for their AVF, including unroofing of a pseudoaneurysm requiring emergent surgical ligation (n=1), residual flow found at follow up requiring surgical ligation (n=2), and surgical removal of the AVF to allow space for a new AVG (n=1). Average total inventory cost of the procedures was $4,234 ± $4,706 (range $910 - $19,213) for all procedures, $3,141 ± $1,477 (range $1,875 - $4,764) for coils alone, $4,496 ± $6,067 (range $910 - $19,213) for endovascular plugs alone, and $4,206 ± $3,688 (range $1,248 - $14,948) for endovascular plugs plus coils. There was no statistically significant difference in cost of inventory between type of embolic (p=0.91).
Conclusions: The results of this study support endovascular occlusion as a safe and effective alternative to surgical ligation for complicated AV circuits. Costs of the inventory used in the procedure can vary widely but are on average similar between the choice of embolic. Further investigation may be able to determine the cost-effectiveness of endovascular occlusion versus surgical ligation.