Summary
End Stage Renal Disease (ESRD) is a significant public health problem. During the last few decades, there is increasing prevalence of patients requiring hemodialysis (102).
The primary use of autogenous arteriovenous access for chronic hemodialysis is recommended by NKF-DOQI guidelines. The Brescia-Cimino wrist (radio cephalic) fistula remains the first option of choice for access (20). When distal peripheral vessels are too tiny and not suitable for creation of radio cephalic fistula, brachio cephalic and brachio basilic fistulae are indicated (85).
When autogenous arteriovenous fistula creation is impossible or the fistula has failed, one may decide to implant grafts as a vascular access conduit. These grafts may be autogenous such as great saphenous vein translocation or homologous vein implants (139) or synthetic such as PTFE (Gortex) material but Prosthetic grafts have inferior primary and secondary patency rates and higher incidence of some complications such as infections and stenosis formation (mostly at the graft vein anastomosis) leading to thrombotic occlusion within 12 to 24 months compared with autogenous fistulae (122)
This study was conducted in the period from March 2018 to February 2020 , prospective randomized controlled study included 60 patients with a clinical diagnosis of end-stage renal failure (ESRF) requiring hemodialysis. Thirty patients were operated upon by saphenous graft for brachio-axillary shunt while the other thirty patients were operated upon by synthetic graft (PTFE) for brachio-axillary shunt.
Summary
115
A) Saphenous group:
Great Saphenous Vein (GSV) was translocated from the thigh under spinal anesthesia and implanted in the arm in a lateral subcutaneous tunnel under regional anesthesia. The fistula was used for hemodialysis after a minimum period of 4 weeks (after maturation of the vein).
B) Synthetic group:
Synthetic graft PTFE was implanted in the arm in a lateral subcutaneous tunnel between brachial artery and axillary vein under local anesthesia.The graft was used for dialysis after a minimum period of 10 days. The patients were followed up for a period of 1 year to assess the patency of AVF and the presence of complications such as infection, stenosis, aneurysm formation, thrombosis, venous hypertension and steal syndrome.
In our study, group I (saphenous) included 30 patients and group II (synthetic) included 30 patients. The difference in age, sex and associated diseases between 2 groups was not statistically significant. Mean total operation time for saphenous group was significantly longer than that for synthetic group (p value |
