Cost-effect analysis of endovascular intervention to central vein stenosis in hemodialysis population

Objective To evaluate the clinical features and the survival benefits of Chinese hemodialysis (HD) patients with central vein stenosis (CVS) undergoing different treatments. Methods From January 1, 2011 to Dec 31, 2012, 116 HD patients at high risk of CVS in Wuhan Central Hospital had their bilateral central veins assessed by vascular ultrasound and conventional venography. The clinical outcomes of 24 non-treated asymptomatic CVS patients, 17 non-treated symptomatic CVS patients and 6 treated symptomatic CVS patients were compared. Treatment costs of CVS were recorded and patients' survival rates were estimated by Kaplan-Meier analysis. Results Among 116 patients, 47 were diagnosed with CVS. The time span between symptomatic presentation and the diagnosis of CVS was more than 10 months averagely. Compared with non-CVS patients, the duration of HD in CVS patients was longer [(33.8±14.5) months vs (1.1±0.7) months, P﹤0.01] and the rate of central venous catheter (CVC) insertion was higher (87.2% vs 14.5%, P﹤0.01). Only 6 patients tried to maintain vascular access by endovascular intervention which costed ￥33 500 per person, much higher than other treatment options. While 30 patients refused endovascular intervention for fear of re-stenosis risk and high treatment costs, among whom 28 patients lost their initial vascular access. The 12-month survival rates of non-treated symptomatic CVS patients, treated symptomatic CVS patients and non-treated asymptomatic CVS patients were 84.6%, 88.9% and 87.0%, respectively, and the 24-month survival rates were 38.5%, 61% and 53.9%, respectively. No significant difference was found among the three groups. Conclusions Endovascular intervention may not be the first choice, but an alternative choice for Chinese HD patients with CVS, considering the long term survival benefit and the high treatment cost.