Intraoperative Heparin Use during Upper Extremity Arteriovenous Access Creation Does Not Affect Outcomes.

Autor:	Raulli SJ; Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA., Cheng TW; Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA., Farber A; Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA., Eslami MH; Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA., Kalish JA; Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA., Jones DW; Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA., Rybin DV; Department of Biostatistics, Boston University School of Public Health, Boston, MA., Nuhn M; Division of Transplant Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA., Gautam A; Division of Transplant Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA., Siracuse JJ; Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA. Electronic address: Jeffrey.Siracuse@bmc.org.
Jazyk:	angličtina
Zdroj:	Annals of vascular surgery [Ann Vasc Surg] 2019 Feb; Vol. 55, pp. 216-221. Date of Electronic Publication: 2018 Sep 11.
DOI:	10.1016/j.avsg.2018.06.031
Abstrakt:	Background: There are conflicting data about the effect of heparin use on perioperative outcomes during upper extremity arteriovenous (AV) access creation. Our goal was to assess the effect of the use and degree of intraoperative heparin on perioperative outcomes after AV access creation. Methods: All upper extremity AV access cases performed at a tertiary academic medical center between 2014 and 2017 were reviewed. Patient and procedural details including intraoperative heparin use and dosing as well as protamine use were analyzed. Full heparin dose was defined as 80-100 U/kg and partial heparin dose as less than 80 U/kg. Perioperative arterial thrombosis or distal embolism, hematoma, and early loss of primary patency within 30 days were evaluated. Multivariate analysis was performed to assess the effect of heparin use. Results: There were 550 AV access cases identified: brachiocephalic (37.5%), brachiobasilic (29.3%), and radiocephalic fistulas (12.9%), and AV grafts (16.9%). Average patient age was 62.6 years and 58.9% were male. Full heparinization was used in 21.3%, partial heparinization in 58.7%, and no heparin was used in 20% of cases. Protamine was used in 94.9% of full heparin cases and 51.4% of partial heparin cases. No perioperative arterial thrombosis or distal embolism was observed. Perioperative wound hematoma rate was 3.4%, 3.1%, and 0.9% in full heparin, partial heparin, and no heparin cohorts, respectively (P = 0.42). Early loss of primary patency was 11.1%, 7.7%, and 6.4% for full heparin, partial heparin, and no heparin cases, respectively (P = 0.39). There were no differences in return to the operating room or perioperative survival. On multivariable analysis, full heparin use (odds ratio [OR] 3.82, 95% confidence interval [CI] 0.41-35.9, P = 0.24) and partial heparin (OR 4.03, 95% CI 0.5-32.6, P = 0.19) use were not significantly different from no heparin cases with respect to 30-day perioperative hematoma rate. Full heparin (OR 1.76, 95% CI 0.65-4.78, P = 0.26) and partial heparin (OR 1.13, 95% CI 0.46-2.75, P = 0.79) were not significantly different from no heparin cases with respect to early loss of primary patency. Conclusions: Intraoperative heparin use, at full or partial doses, did not affect perioperative outcomes after AV access creation. Overall complication event rate was low for all groups. AV access can be safely performed without intraoperative heparin use. (Copyright © 2018 Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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