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

Area of Science:

• Vascular Surgery
• Nephrology
• Anesthesiology

Background:

• Conflicting data exists regarding the impact of heparin on perioperative outcomes in arteriovenous (AV) access creation.
• Assessing the effect of intraoperative heparin use and dosage on AV access outcomes is crucial.

Purpose of the Study:

• To evaluate the influence of intraoperative heparin administration and its dosage on perioperative outcomes following upper extremity AV access creation.
• To determine if heparin use affects complication rates such as thrombosis, embolism, hematoma, and early patency loss.

Main Methods:

• Retrospective review of 550 upper extremity AV access cases (2014-2017).
• Analysis of patient and procedural details, including intraoperative heparin dose (full: 80-100 U/kg, partial: <80 U/kg), and protamine use.
• Evaluation of perioperative arterial thrombosis/embolism, hematoma, and 30-day primary patency loss using multivariate analysis.

Main Results:

• No perioperative arterial thrombosis or distal embolism observed across all groups.
• Perioperative hematoma rates were similar: 3.4% (full heparin), 3.1% (partial heparin), and 0.9% (no heparin) (P=0.42).
• Early primary patency loss rates were also similar: 11.1% (full heparin), 7.7% (partial heparin), and 6.4% (no heparin) (P=0.39).

Conclusions:

• Intraoperative heparin use, regardless of dose, did not significantly alter perioperative outcomes after AV access creation.
• The overall complication rate was low across all heparin use groups.
• AV access procedures can be safely performed without the routine use of intraoperative heparin.