Effects of Heparin on Early Patency of Arteriovenous Fistula in Angioaccess Surgery of Patients with End-Stage Renal Disease

Mohamamd Mozafar, Fatemeh Hoseinzadegan, Saran Lotfollahzadeh, Maryam Baikpour, Razie Amraei, Farhad Solatpour, Masoud Baikpour

Abstract

Background: Arteriovenous fistula (AVF) is now the optimal method of obtaining vascular access for dialysis. Measures such as systemic anticoagulation have been proposed as means of increasing patency rates but enough evidence does not exist to support their application. We aimed to evaluate the efficacy of preoperative heparin injection on patency of AVF during the first 24 hours after surgery and to determine whether such measure can be used to prevent early thrombosis of the vascular access.

Methods: The study was carried out on 150 patients admitted to Shohada-e-Tajrish hospital for permanent vascular access placement during 2011-2012. 75 patients were randomly assigned to receive 100 units/kg of heparin intraoperatively and at 24 hours post-surgery AVF patency rate was assessed and compared to the control group. 

Results: All the 75 patients who had received heparin intraoperatively had a patent arteriovenous fistula 24 hours post-surgery which showed a statistically significant difference compared to the control group among which only 69 (92%) patients had a functioning AV fistula (p-value= 0.028).

Conclusions: Our results show that systemic anticoagulation with heparin can be considered as an effective option in preventing vascular access failure. However, considering the contradictory data on the usefulness of heparin injection, larger trials are needed to evaluate efficacy and adverse effects of systemic intraoperative anticoagulation in End-Stage Renal Disease (ESRD) patients before qualifying it as a method of increasing AVF patency in these patients

Keywords

Arteriovenous fistula, Heparin, Vascular patency, Chronic kidney failure

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References

Coresh J, Selvin E, Stevens LA, Manzi J, Kusek JW, Eggers P, et al. Prevalence of chronic kidney disease in the United States. Jama. 2007;298(17):2038-47.

Levey AS, de Jong PE, Coresh J, El Nahas M, Astor BC, Matsushita K, et al. The definition, classification, and prognosis of chronic kidney disease: a KDIGO Controversies Conference report. Kidney international. 2011;80(1):17-28.

Phadke G, Khanna R. Renal replacement therapies. Missouri medicine. 2010;108(1):45-9.

Zhang Q-L, Rothenbacher D. Prevalence of chronic kidney disease in population-based studies: systematic review. BMC public health. 2008;8(1):117.

Allon M, Robbin ML. Increasing arteriovenous fistulas in hemodialysis patients: problems and solutions. Kidney international. 2002;62(4):1109-24.

Haimov M, Baez A, Neff M, Slifkin R. Complications of arteriovenous fistulas for hemodialysis. Archives of Surgery. 1975;110(6):708-12.

Perera GB, Mueller MP, Kubaska SM, Wilson SE, Lawrence PF, Fujitani RM. Superiority of autogenous arteriovenous hemodialysis access: maintenance of function with fewer secondary interventions. Annals of vascular surgery. 2004;18(1):66-73.

Abularrage CJ, Sidawy AN, Weiswasser JM, White PW, Arora S. Medical factors affecting patency of arteriovenous access. Seminars in vascular surgery. 2004;17(1):25-31.

Green LD, Lee DS, Kucey DS. A metaanalysis comparing surgical thrombectomy, mechanical thrombectomy, and pharmacomechanical thrombolysis for thrombosed dialysis grafts. Journal of vascular surgery. 2002;36(5):939-45.

Smith GE, Gohil R, Chetter IC. Factors affecting the patency of arteriovenous fistulas for dialysis access. Journal of vascular surgery. 2012;55(3):849-55.

Ravari H, Kazemzade G, Sarookhani A, Khashayar P. Effect of heparin on the patency of arteriovenous fistula. Acta Medica Iranica. 2008;46(5):379-82.

Erkut B, Ünlü Y, Ceviz M, Becit N, Ates A, Çolak A, et al. Primary arteriovenous fistulas in the forearm for hemodialysis: effect of miscellaneous factors in fistula patency. Renal failure. 2006;28(4):275-81.

Dember LM, Beck GJ, Allon M, Delmez JA, Dixon BS, Greenberg A, et al. Effect of clopidogrel on early failure of arteriovenous fistulas for hemodialysis: a randomized controlled trial. Jama. 2008;299(18):2164-71.

Ghorbani A, Aalamshah M, Shahbazian H, Ehsanpour A, Aref A. Randomized controlled trial of clopidogrel to prevent primary arteriovenous fistula failure in hemodialysis patients. Indian journal of nephrology. 2009;19(2):57.

Akin EB, Topçu Ö, Özcan H, Ersöz S, Aytaç S, Anadol E. Hemodynamic effect of transdermal glyceryl trinitrate on newly constructed arteriovenous fistula. World journal of surgery. 2002;26(10):1256-9.

Tessitore N, Bedogna V, Poli A, Mantovani W, Lipari G, Baggio E, et al. Adding access blood flow surveillance to clinical monitoring reduces thrombosis rates and costs, and improves fistula patency in the short term: a controlled cohort study. Nephrology Dialysis Transplantation. 2008;23(11):3578-84.

Sharathkumar A, Hirschl R, Pipe S, Crandell C, Adams B, Lin J. Primary thromboprophylaxis with heparins for arteriovenous fistula failure in pediatric patients. The journal of vascular access. 2006;8(4):235-44.

Bhomi K, Shrestha S, Bhattachan C. Role of systemic anticoagulation in patients undergoing vascular access surgery. Nepal Med Coll J. 2008;10(4):222-4.

D'Ayala M, Smith RM, Martone C, Briggs W, Deitch JS, Wise L. The effect of systemic anticoagulation in patients undergoing angioaccess surgery. Annals of vascular surgery. 2008;22(1):11-5.

Wang BR, Rowe VL, Ham SW, Han S, Patel K, Weaver FA, et al. A prospective clinical evaluation of the effects of intraoperative systemic anticoagulation in patients undergoing arteriovenous fistula surgery. The American surgeon. 2010;76(10):1112-4.

Charlton-Ouw KM, Nosrati N, Miller 3rd C, Coogan SM, Safi HJ, Azizzadeh A. Outcomes of arteriovenous fistulae compared with heparin-bonded and conventional grafts for hemodialysis access. The journal of vascular access. 2011;13(2):163-7.

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