Efficacy of Dextran Solutions in Vascular Surgery

Abstract

The purpose of this paper is to discuss the role and efficacy of dextran in vascular procedures using evidence-based data from the review of surgical literature. A medline search using "dextran,'' "vascular surgery,'' and "antiplatelet therapy'' as keywords was performed for English-language articles. Further references were obtained through cross-referencing the bibliography cited in each work. Dextran is commonly used in carotid endarterectomy (CEA) patients where the embolic rate is reduced by 46%, resulting in fewer procedure-related strokes. As a prophylactic agent against thrombosis, multiple randomized studies have reported its benefit over other antithrombotic medications. Dextran is also particularly useful in "difficult'' infragenicular lower extremity bypasses where artificial grafts (such as polytetrafluoroethylene [PTFE] or umbilical vein) are used in the setting of poor outflow vessels, or those with composite grafts and small-caliber venous conduits. Distal bypasses with adjunctive procedures (eg, arteriovenous fistula or anastomotic cuffs) also have a better outcome with the addition of dextran. Dextran has numerous important implications in vascular surgery, in particular with CEA patients or "difficult'' infragenicular bypasses. Its effectiveness with endovascular stents remains unknown.

Short and long term biocompatibility of NeuroProbes silicon probes

“…Dex is an antithrombotic agent helping clot lysis (for reviews see Abir et al, 2004;Johnson and Barker, 1992), whereas DexM is an agent decreasing inflammatory response (Shain et al, 2003;Spataro et al, 2005;Zhong and Bellamkonda, 2007;Zhong et al, 2005). Since all coating molecules are known to reduce tissue reaction, we expected better neuronal survival around coated probes.…”

“…Dex reduces blood viscosity, erythrocyte aggregation and platelet adhesiveness resulting in a better lysis of clots (for reviews see Abir et al, 2004;Johnson and Barker, 1992). We therefore expected a reduced tissue reaction around Dex coated probes that had induced bleeding.…”

“…Dex is a complex polysaccharide, used medicinally as an antithrombotic agent to reduce blood viscosity and vascular thrombosis (Gallus and Hirsh, 1976). It binds erythrocytes, platelets, and vascular endothelium, so reducing erythrocyte aggregation and platelet adhesiveness (for reviews see Abir et al, 2004;Johnson and Barker, 1992). Clots formed in the presence of Dex are more easily lysed due to an enhanced fibrinolysis (Jones et al, 2008).…”

Remodeling of the Aortic Neck with a Balloon-Expandable Stent Graft in Patients with Complicated Neck Morphology

“…Dextran is cleared renally, with the renal clearance inversely proportional to the size of the molecule; therefore, the half-life of dextran relates to its molecular weight, ranging from 7.5 to 12 hours. 16 Dextran has multiple effects, including platelet inhibition, 17 diminished fibrin polymerization, 18 decreased blood viscosity and erythrocyte rouleaux formation, 19 and an increase in plasma volume. Physicians need to treat patients with congestive heart failure with caution, and patients with borderline renal function may experience deterioration in their kidney function.…”

“…16 The two forms of dextran used clinically are dextran 40 and dextran 70, which have molecular weights of 10,000 to 75,000 and 20,000 to 115,000, respectively. Dextran is cleared renally, with the renal clearance inversely proportional to the size of the molecule; therefore, the half-life of dextran relates to its molecular weight, ranging from 7.5 to 12 hours.…”