مقايسه نتايج درماني برداشت وريد صافن بزرگ با روش هاي مرسوم و بريجينگ استاندارد

Comparison of therapeutic results of large saphenous vein resection with conventional methods and standard bridging

استفاده از تكنيك مرسوم در برداشت وريد صافن با عوارض زخم و تاخير در حركت بيمار همراه است. از اين رو منجر به ايجاد روش هاي كم تهاجمي مانند روش بريجينگ شد. در اين مطالعه، نتايج درماني برداشت وريد صافن بزرگ با روش هاي مرسوم و بريجينگ براي بازسازي عروق اندام تحتاني در بيماران مبتلا به ايسكمي مزمن اندام تحتاني مقايسه شد. روش بررسي در اين مطالعه كارآزمايي باليني تصادفي شده (IRCT20190511043562N1)، 66 بيمار مبتلا به ايسكمي مزمن اندام تحتاني، به صورت تصادفي به دو گروه برداشت وريد صافن بزرگ با روش مرسوم (30 تايي) و روش استاندارد Bridging (36 تايي) تقسيم شدند. ميزان درد Patency گرافت، عوارض زخم، نتايج جراحي و ميزان رضايتمندي بيماران ثبت شد. مدت پيگيري بيماران شش ماه بود. يافته ها باز بودن گرافت (353/0=P)، ميزان بقاء اندام بدون آمپوتاسيون (397/0=P) و تغييرات نمره درد هنگام استراحت (846/0=P) و حركت (380/0=P) بين دو گروه تفاوت معناداري را نشان نداد. يك هفته پس از عمل، ميزان بروز عفونت در روش بريجينگ كاهش معناداري را نشان داد (045/0=P). طي شش ماه پيگيري ميزان بهبود زخم، برطرف شدن درد ايسكميك، بهبود لنگش پا در روش بريجينگ بهتر بود اما تفاوت معناداري را نشان نداد (05/0

The use of the traditional method for saphenous vein harvesting is associated with wound complications and not on-time patient mobilization. This has caused the improvement of minimally invasive vein harvesting techniques, together with general bridging. This study was designed to compare the therapeutic results of large saphenous vein harvesting with conventional and standard bridging techniques for lower extremity vascular reconstruction in patients with chronic lower extremity ischemia. Methods: In this randomized clinical trial study, 66 patients with chronic lower extremity ischemia were randomly divided into two groups: large saphenous vein harvesting by conventional technique (continuous longitudinal incision) (n=30) and standard Bridging technique (small and multiple incisions) (n=36). Pain score (VAS), graft patency, wound complications, surgery results and patient satisfaction was recorded. The follow-up period was six months. (IRCT20190511043562N1). Results: Graft patency (P=0.353), and Amputation-free Survival (P=0.397) did not show a significant difference between the two groups. Changes in pain score at rest (P=0.846) and movement (P=0.380) at different times did not show a significant difference between the two groups. One week after the operation, the incidence of infection in the bridging technique showed a significant decrease (P=0.045). During the six months of follow-up, the wound healing rate, ischemic pain relief, and claudication improvement were better in the bridging technique but did not show a significant difference with the conventional technique (P<0.05). Patient satisfaction was higher in the bridging technique but did not show a significant difference between the two groups (P<0.05). Conclusion: It seems that the use of the bridging technique in venous resection large saphenous vein harvesting is associated with reducing wound complications and pain, reducing the length of hospital stay, increasing the speed of wound healing, and improving patient satisfaction. The duration of graft patency and Amputation-free Survival were similar in the two groups. We believe that each technique has advantages and disadvantages that should be considered by the patient and surgeon when choosing a surgical procedure.