CLINICAL AND ECONOMIC EFFECTIVENESS OF ENDOVASCULAR ANGIOPLASTY OF NATIVE ARTERIOVENOUS FISTULAS UNDER ULTRASOUND AND X-RAY CONTROL

For hemodialysis patients, ensuring safe and effective vascular access using an arteriovenous fistula or graft is a top priority. Arteriovenous access dysfunction is associated with increased hospitalization and mortality, so access preservation strategies are important.
Performing endovascular access correction under ultrasound guidance has a number of advantages, including economic ones, over traditional procedures using X-ray imaging.
Objective. Study and analysis of the clinical and economic effectiveness of endovascular angioplasty of native arteriovenous fistulas under ultrasound and X-ray control.
Material and methods. A retrospective analysis was conducted of a group of patients on renal replacement therapy (RRT), hospitalized at the Nizhnevartovsk District Clinical Hospital with permanent vascular access dysfunction (PVD) and operated on using the endovascular method with ultrasound navigation and X-ray control from January 2018 to February 2023.
27 patients (12 men, 15 women), whose average age was 57.12±12.95 years old, underwent 33 procedures of endovascular access correction under ultrasound control, 28 patients (10 men and 18 women), whose average age was 59, 12±11.94 years old, 35 procedures of endovascular access correction under X-ray control were performed.
To determine economic efficiency, a cost-effectiveness ratio (CER) analysis was used. The necessary costs for surgical treatment that are clinically and technically effective and allow the resumption of hemodialysis through an AVF have been determined. The efficiency index (EI) for ultrasound imaging was 736.4 rubles. EI = 69960/95 = 736.4 rub. With X-ray control – 1267.7 rubles per unit of efficiency: EI = 120440/95 = 1267.7 rub.
Conclusion. A list of economic costs for performing endovascular angioplasty of arteriovenous access under ultrasound and Xray visualization is presented and justified. A comparative analysis of these methods was carried out taking into account clinical and economic effectiveness. The economic advantages of ultrasound-guided angioplasty were noted. The conducted clinical and economic analysis showed that the cost of endovascular procedures under ultrasound control is 1.72 times lower than under X-ray visualization. Both methods are comparable in terms of immediate clinical results and have a minimal number of complications, but the introduction of methods for endovascular correction of AVF dysfunctions under ultrasound control will significantly reduce the costs of a medical institution for the treatment of this pathology.

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