Peripheral Vascular Surgery Society

 #9 COST COMPARISON OF CRYOVEIN IMPLANTATION VERSUS GRAFT EXCISION IN TREATING INFECTED HEMODIALYSIS GRAFTS.

John H. Matsuura, MD, David Rosenthal, MD, Louis F. Knoepp, MD, Kathryn A. Clarke, BS, and Michael D. Clark, MD

Atlanta Medical Center, Atlanta, GA.

Background: One of the most difficult challenges in angioaccess is treating infected arteriovenous (AV) grafts. The incidence of graft infection averages 10-19%, and can carry up to a 10% mortality in the renal failure population. Cryopreserved femoral vein has been used successfully in treating AV graft infections, but questions have been raised regarding the cost effectiveness of this approach with the price of cryovein averaging $2,500. Therefore we wished to evaluate the cost of treating infected AV grafts by complete graft excision alone versus the use of cryovein.

Methods: We retrospectively reviewed the hospital costs for 33 patients that were admitted with a primary diagnosis of an infected AV graft. All hospitalizations were within the last three years and cost data was represented in 1999 dollars using a relative value scale. Thirteen patients were treated with complete graft excision, local wound care, and antibiotics; while 20 patients had complete graft excision and immediate implantation of a cryovein AV graft during the same operation. Cost information was obtained from the hospital finance department and reflects a combination of direct hospital costs for ancillary services and supplies, as well as hospital charges for operating room, recovery room, hospital room, and anesthesia fees. The surgeon's charges and subsequent hospitalizations were excluded from the analysis. Statistical analysis was conducted using the MANN-Whitney test.

Results: The average hospital length of stay for the cryovein group was 2.3 days compared to 8.1 days for the graft excision group (p=0.001). The operating room charges were higher in the cryovein group, averaging $8138±2908 compared to $6731±4517 for infected graft excision alone, and this was related to the added expense of the cryovein. The overall hospital cost in the cryovein group, however, was lower at $13,843±6007 compared to $22,136±12,655 for the graft excision group.

Conclusion: Total hospital cost is higher with conventional excision of an infected AV graft and is a result of longer hospitalization and additional ancillary service costs. Cryopreserved femoral vein is a cost-effective means of treating infected AV grafts. The shorter hospitalization and fewer demands on wound care are distinct advantages for cryovein in our current managed care environment.

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Last updated January 1,2000