Zusammenfassung
GRUNDLAGEN: Patienten an der chronischen Hämodialyse benötigen einen adäquaten Dialysezugang durch eine AV-Fistel, arteriovenöse Interponate an den oberen oder unteren Extremitäten oder perkutan eingebrachte Dialysekatheter. Zielsetzung der folgenden Untersuchung war es, autologe Vena saphena magna mit PTFE als Gefäßersatzmaterial bei Oberschenkelshunts zu vergleichen. METHODIK: 70 Patienten wurden im Rahmen einer prospektiv randomisierten Studie in 2 Gruppen untersucht. In beiden Gruppen wurden die Oberschenkelshunts in Schleifenkonfiguration angelegt. In der einen Gruppe wurde autologe Vena saphena magna, in der anderen Gruppe PTFE als Gefäßersatzmaterial verwendet. Im Rahmen des Follow-up wurden in definierten Abständen die Shuntfunktion mittels Dopplersonographie und das Auftreten von Komplikationen nachuntersucht. ERGEBNISSE: In Bezug auf die Shuntfunktion, dem Auftreten von postoperativen Shuntthrombosen und die Durchflussraten konnte kein statistisch signifikanter Unterschied zwischen den beiden Gruppen festgestellt werden (p < 0,8). Infektionen wurden häufiger in der PTFE-Gruppe beobachtet (p < 0,05). SCHLUSSFOLGERUNGEN: Zusammenfassend ist die autologe Vena Saphena magna, aufgrund der signifikant niedrigeren Infektionsrate, eine gute Alternative zu PTFE als Gefäßersatzmaterial für Oberschenkelshunts.
Summary
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 and temporary catheters. The purpose of this study is to compare the saphenous vein loop fistula as a venous autograft versus using the synthetic Gore-tex vascular graft for creating loop A–V fistula in thigh for hemodialysis. METHODS: In the context of a prospective randomized study, seventy patients needing bridge fistula for dialysis access were randomly divided into two groups. We performed the loop saphenous A-V fistula in the test group and the Gore-tex loop bridge fistula in the control group. An assessment was made of the function criteria (fistula thrill and murmur) and complications (infection and thrombosis) in planned intervals. At the end of a year of follow-up the flow rate of all fistulas were assessed by means of Doppler sonography. These data were compared with each other. RESULTS: Comparing the function criteria (fistula murmur and thrill) of the loop saphenous A–V fistula and the Gore-tex method showed no significant differences (p < 0.8). There was no significant difference between the two groups in thrombosis (p < 0.8). The infection rate of the Gore-tex method was significantly high (p < 0.05). However, the flow rates showed no significant differences (p < 0.8). CONCLUSIONS: Essentially we showed that arteriovenous fistula was an acceptable alternative for arteriovenous graft in the thigh for performing chronic hemodialysis and that saphenous vein loop arteriovenous fistula was superior to Gore-tex loop arteriovenous graft from some aspects.
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Moussavi, S., Tofigh, A. Comparing the saphenous vein with the Gore-tex bridge fistula in thigh for chronic hemodialysis. Eur Surg 39, 355–358 (2007). https://doi.org/10.1007/s10353-007-0365-x
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DOI: https://doi.org/10.1007/s10353-007-0365-x