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Selective use of heparin in aortic surgery
J Burnett1, J Payne, A C Gray-Weale
1University of Sydney, Department of Surgery, Repatriation General Hospital, Concord, New South Wales.
The Australian and New Zealand Journal of Surgery
|October 1, 1988
Summary
Systemic heparin use in aortic reconstruction increases blood loss and operative time. Heparinization is not required for aneurysm surgery without occlusive disease but remains essential for occlusive disease procedures.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Surgical Outcomes
Background:
- Distal ischemia following aortic reconstruction occurs in up to 25% of cases, even with systemic heparin.
- Anticoagulation with heparin may lead to increased operative blood loss.
Purpose of the Study:
- To assess the prevalence of distal ischemia and associated complications after aortic reconstruction.
- To evaluate the impact of systemic heparin on blood loss and operative time in aortic aneurysm surgery.
Main Methods:
- Retrospective study of consecutive patients undergoing aortic reconstruction over 30 months.
- Evaluation of 161 patients with aortic aneurysm and 38 with occlusive disease.
- Quantification of blood loss and operating time in patients undergoing aortic aneurysm resection.
Main Results:
- Vessel occlusion incidence was 21% in the occlusive disease group versus 4% in the aneurysm group (P < 0.05).
- Major vessel occlusion led to serious complications in 4 of 7 patients and two deaths, despite heparin.
- Heparin use in aneurysm surgery significantly increased blood loss and operating time (P < 0.05).
Conclusions:
- Aneurysm surgery without distal occlusive disease can be safely performed without systemic heparin.
- Heparinization remains necessary for aortic reconstruction in patients with occlusive disease.