مقايسه تاثير وريد ضامن اتولوگ با گرافت گورتگس بر فيستولهاي پلي ناحيه ران

Comparing the effects of autologue saphenous vein and GOR-TEX graft in loop A-V fistulae of thigh

Background: Performing chronic hemodialysis in patients suffering from end stage renal disease needs a suitable vascular access like A-V fistula in upper limbs , bridge fistula in upper or lower limbs,and use of permanent or temporary catheters. The purpose of this study was to compare the saphenous vein loop fistula as a venous autograft versus the synthetic Cortex vascular graft for creating loop A-V fistula in the thigh for hemodialysis. Using on autologue vein instead of costly synthetic materials and technical feasibility because of one vascular anastomosis in lieu of two in the other method , are the features of our proposed method. Materials and methods: In a single blind, randomized and matched controlled clinical trial, sixty petients who need a bridge fistula for dialysis access were randomly divided in two groups. The groups were matched for the underlying diseases including diabetes melitus and HTN.The loop saphenous A-V fistula was performed in the test group and the Gortex loop bridge fistula in the control group. Then the function criteriae (fistula thrill and murmur) and complications in planned intervals were assessed. At the end of a year of follow up, the flow rate of all fistula were assessed by means of Doppler sonography. The data were compared with each other. Results: The function criteriae of the loop saphenous A-V fistula and the Cortex method had not significant differences (p<0.8). Also a significant difference concerning thrombosis of the fistula between the two groups were not observed(p<0.8). But, the infection rate of the Gortex method was significantly higher than the saphenous method (p<0.05). The flow rate of the fistula showed no significant difference in two groups(p<0.8). Conclusion: Thigh loop A-V fistula provides a satisfactory vascular access for hemodialysis with similar function criteria and lower infection rate in comparison with Gortex loop A-V bridge fistula in thigh. Concerning the cost and facility of its use, thigh saphenous loop A-V fistula could be a good substitude for the routine use of synthetic grafts in dialysis access surgery.