Original articleprior to the anticipated date of dialysis commencement. If haemodialysis is required before this time, or if complications arise with the initial AVF creation (25%-35% of AVF fail at an early stage), then an alternative method of dialysis, generally via TCVC, is required (2).Dialysis via a TCVC confers significantly higher risk of infection, mortality and central venous stenosis than dialysis via an AVF. A recent national Scottish study of 2666 patients revealed a 2-to 3-fold increased risk in mortality (all-cause mortality, cardiovascular or infection related mortality) and a 7-fold increase in death from septicaemia with the use of TCVCs (3). The complications of vascular access are responsible for over 20% of all hospitalisations of patients on haemodialysis and account for one-third of all in-patient renal bed usage (4). It therefore follows that a strategy of TCVC minimisation or avoidance is likely to have significant benefits both to the individual and to the health service generally.Arteriovenous grafts (AVGs) may provide an alternative means of achieving vascular access in patients requiring

A291 ture. We assumed re-intervention and septicaemia rates of ecAVG were equivalent to standard AVGs. Resource use was based on hospital practice and unit costs from published National Health Service datasets. Results: Over a 6 month period, total treatment costs per patient were £5,882 in the TCVC strategy and £4,954 in the ecAVG strategy, delivering potential savings of £927 per patient. Although ecAVG's had higher procedure and re-intervention costs reflecting longer procedure time and device costs (£3,014 vs £1,836), these were offset by significant reductions in septicaemia treatment costs (£1,322 vs £2,176) and in-patient waiting time bed costs (£619 vs £1,870). ConClusions: Adopting ecAVG's as an alternative to TCVCs can potentially deliver cost savings in this hospital. The two treatment strategies will now be assessed in a RCT.

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