السالكية الثانوية بعد الترقيع الوريدي ضد التوسيع بالبالون لعلاج التبطين الحديث للمفاغره الوريديه لوصلة شريانية وريدية صناعية متجلطة للاستصفاء الدموي

Abstract

Background: The pathogenesis of neointimal hyperplasia (NH) associated with hemodialysis arterio-venous grafts (AV grafts) is complex and likely involves surgical manipulation of the tissues, material bioincompatibility, and mechanical factors. Both surgical and radiological interventions for stenosed and thrombosed AV graft have been described aiming at the optimal restoration of morphology and function. Aim of the work: to compare the secondary patency after patch venoplasty and balloon venoplasty in management of neointimal hyperplasia of the venous anastomosis of arterio-venous graft for dialysis. Patients and Methods: This is a double armed randomized prospective study that was carried out at Ain Shams University hospitals for 2 years. Twenty patients with thrombosed synthetic AV graft were enrolled in this study. The first group (10 patients) was treated with patch venoplasty and the second group (10 patients) with balloon venoplasty adjunctive after surgical thrombectomy. Results: Graft patency at 6 and 12-month follow up was 90%, 70% for the balloon angioplasty group vs 60% and 40% for the surgical patch venoplasty group (p-value: 0.3 and 0.37 respectively). Conclusion: In the present study, the outcome of balloon venoplasty was better than and patch venoplasty for thrombosed AV grafts. In addition to better graft patency, balloon venoplasty offers the advantage of shorter operative time, and lower morbidity. Further studies with large sample size and multicentric cooperation are required to confirm the present findings.