IYSC05 - The Cost-effectiveness of Using Stent Graft to Treat New “Stent Graft-vein Junction” Stenosis for Dysfunctional Arteriovenous Graft

Objectives: Stent grafts (SG) have been widely used in management of recoiled and repeated vein-graft junction (VGJ) stenosis in arteriovenous grafts (AVGs). Proximal edge of SG-vein junction (SGVJ) was a new common cause of target lesion revasculization. The rationale of using SG to treat this SGVJ lesion remains unknown.

Methods: We retrospectively enroll all SGs putting on SGVJ for dysfunctional AVGs from May, 2011 to November, 2023 in our center. Primary patency (PP), assisted primary patency (APP), target-lesion primary patency (TLPP), secondary patency (SP) and access survival (AS) of the proximally stacked SGs were calculated in Kaplan-Meier survival analysis and the patency of the 2nd and 3rd SG were compared to the 1st SG. The daily cost of keeping non-surgically revised AS of the stacking SGs were calculated. SGs placed for distal edge lesion and ruptured graft during angioplasty were excluded.

Results: There were 205 SG stacked proximally on a previously-placed SG for a SGVJ lesion in total 136 AVGs, 127 patients. The mean age was 71±14. There were 51 grafts receiving 3rd SG and 18 grafts receiving 4th SG and 3 grafts receiving 5th SG. Mean duration from AVG creation to the first SG for VGJ stenosis was 17 months with the mean follow-up duration 22 months. The 6-month PP, APP, SP and AS of the first SGs was 11.3%, 19.5%, 40.6% and 83.2%, respectively. Mean duration from the first o 2nd SG and 3rd SG was the same 9.4 months. The 6-month PP/APP/SP/AS of 2nd and 3rd SG were 40.9% vs 48.9%/47.6% vs 54.0%/ 76.9% vs 80.0%, 84.1% vs 82.2%, respectively. The patency was no difference between the 2nd and 3rd SG. But the TLPP of the 2nd and 3rd SG was better than 1st SG. (p=0.000 and 0.04, respectively) (Fig 1) And the AS of 2nd and 3rd SG were significantly worse than 1st SG. (p=0.001 and 0.003, respectively) The daily costs to maintain AS without surgical revision were 74/95/55 USDs, respectively. (p>0.05) (Fig 2)

Conclusions: The 6-month patency of the 1st SG in this case series was unsatisfactory. The proximally-stacked 2nd and 3rd SG for a new SGVJ lesion had significantly better TLPP than 1st SG. But the costs to maintain non-surgically revised AS are considerable. Extended indication of SG for a new SGVJ stenosis needs more long-term cost-effectiveness evaluation and larger-scale follow-up data.