The Effect of Systemic Anticoagulation in Patients Undergoing Angioaccess Surgery

D’Ayala, Marcus; Smith, Robina M.; Martone, Catherine; Briggs, William T.; Deitch, Jonathan; Wise, Leslie

doi:10.1016/j.avsg.2007.09.002

Cited by 24 publications

(29 citation statements)

References 8 publications

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“…In one patient, angioaccess was made with Gore-Tex graft. The mean operative time was not significantly different in any of the groups, which is compatible with the results of previous studies (8,20).…”

Section: Discussionsupporting

confidence: 82%

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Effect of Intra Operative Intravenous Injection of Heparin on Patency Rate of Radio Cephalic Autogenous Arteriovenous-Fistula in Chronic Renal Failure Patients

Ebrahimifard

2015

Arch Crit Care Med

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Background: Currently, there is no standard for the use of systemic heparin during creation of Arteriovenous (AV) fistula to decrease the incidence of postoperative thrombotic complications. Objectives: The goal of this study was to evaluate the effects of intra-operative IV heparin on patency rate and postoperative bleeding complications in patients undergoing surgery for AV fistula. Patients and Methods: A prospective, randomized controlled study was performed on 50 patients undergoing AV fistula creation, who were randomly divided in two groups. The control group received no systemic heparin and the heparin group received 5,000 units of intravenous heparin before clamping of theartery. Results: There was a significant difference in patency rate between the heparin and control groups (96% vs. 72%, P = 0.021), and there were no significant differences in operative time (P = 0.55). Perioperative bleeding was not significantly different between the two groups. Conclusions:The results suggest that intra operative administration of heparin has statistically significant effects on patency rates yet not on postoperative bleeding complications. Larger trials with longer follow-up durations and assessment of maturation rates are needed to determine this effect on fistula outcome.

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Section: Discussionsupporting

confidence: 82%

“…In a study conducted during 2008 by D'Ayala et al (20) complications related to bleeding during and after surgery were significantly higher in the group that received heparin (P = 0.008). In our study there was no significant statistical difference in bleeding, hematoma and oozing intra-operatively or post-operatively between the two groups.…”

Section: Discussionmentioning

confidence: 90%

Effect of Intra Operative Intravenous Injection of Heparin on Patency Rate of Radio Cephalic Autogenous Arteriovenous-Fistula in Chronic Renal Failure Patients

Ebrahimifard

2015

Arch Crit Care Med

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“…Because of that and the persistently high rates of A-V fistula failures, the initiative has not reduced the costs of medical interventions to salvage stenosed fistulae as it was intended (29). In addition, anticoagulant-and antiplatelet-based pharmacological treatments to promote and maintain patency of this type of vascular access have limited impact (10,37), in part because they do not target the formation of NIH, which is the underlying cause of fistula stenosis. This study shows for the first time that inhibition of c-Kit, a target for which there is an existing translatable platform for drug development, effectively prevents neointima formation in experimental A-V fistulae in rodents.…”

Section: Discussionmentioning

confidence: 99%

c-Kit signaling determines neointimal hyperplasia in arteriovenous fistulae

Skartsis

Martinez

Duque

et al. 2014

American Journal of Physiology-Renal Physiology

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Skartsis N, Martinez L, Duque JC, Tabbara M, Velazquez OC, Asif A, Andreopoulos F, Salman LH, Vazquez-Padron RI. c-Kit signaling determines neointimal hyperplasia in arteriovenous fistulae. Am J Physiol Renal Physiol 307: F1095-F1104, 2014. First published September 3, 2014 doi:10.1152/ajprenal.00292.2014.-Stenosis of arteriovenous (A-V) fistulae secondary to neointimal hyperplasia (NIH) compromises dialysis delivery, which worsens patients' quality of life and increases medical costs associated with the maintenance of vascular accesses. In the present study, we evaluated the role of the receptor tyrosine kinase c-Kit in A-V fistula neointima formation. Initially, c-Kit was found in the neointima and adventitia of human brachiobasilic fistulae, whereas it was barely detectable in control veins harvested at the time of access creation. Using the rat A-V fistula model to study venous vascular remodeling, we analyzed the spatial and temporal pattern of c-Kit expression in the fistula wall. Interestingly, c-Kit immunoreactivity increased with time after anastomosis, which concurred with the accumulation of cells in the venous intima. In addition, c-Kit expression in A-V fistulae was positively altered by chronic kidney failure conditions. Both blockade of c-Kit with imatinib mesylate (Gleevec) and inhibition of stem cell factor production with a specific short hairpin RNA prevented NIH in the outflow vein of experimental fistulae. In agreement with these data, impaired c-Kit activity compromised the development of NIH in A-V fistulae created in c-Kit W/Wv mutant mice. These results suggest that targeting of the c-Kit signaling pathway may be an effective approach to prevent postoperative NIH in A-V fistulae. arteriovenous fistula; hemodialysis; neointima THE ARTERIOVENOUS (A-V) fistula is the preferred type of vascular access for hemodialysis patients (29). It achieves higher patency rates, has fewer complications than synthetic grafts (12,29,31), and has a lower risk of infections than central venous catheters (17,29). Despite its advantages, A-V fistulae frequently fail to mature or become dysfunctional after successful dialysis sessions, and this occurs primarily due to the development of neointimal hyperplasia (NIH) within the A-V fistula circuit (2, 5, 39). Stenosed A-V fistulae can sometimes be salvaged through angioplasty or surgical interventions, but these attempts often result in restenosis or additional complications (32). Therefore, there is an unmet medical need for treatments that prevent NIH and improve A-V fistula function. To this end, it is necessary to better define the factors underlying the pathological remodeling of the A-V fistula wall.A-V fistula maturation is a dynamic vascular process with multiple factors contributing to the development of NIH. These include vein configuration (22) In the present study, we investigated the role of c-Kit in the pathological remodeling of A-V fistulae. We show that activation of the c-Kit signaling pathway in adventitial and neointimal cells precedes arteri...

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“…However, D'Ayala et al and Bhomi et al [12,13]. reported a risk of intraoperative bleeding and no beneficial effect in patency.…”

Section: Patient Demographicsmentioning

confidence: 99%

“…have advocated towards the use of intraoperative heparin during dialysis access creation. D'Ayala et al and Bhomi et al [12,13]. have shown an increased risk of bleeding intraoperatively and no beneficial effect on patency.…”

Section: Evidence On Heparin Usementioning

confidence: 99%

Does systemic heparin reduces thrombosis rate of radiocephalic fistula: A double-blinded randomized study

Aimanan¹,

Idris²,

Safri³

et al. 2017

Vascul Dis Ther

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Background/Objective: The National Kidney Foundation Kidney disease outcomes quality initiative guidelines suggest that the creation of more native arteriovenous fistulas (AVFs) would improve the quality of life of end stage renal failure patients. However, the ability to comply with this suggestion is affected by the failure rate of AVFs mainly due to thrombosis. Heparin is a well-accepted treatment to prevent thrombosis in general but has not been suggested in arteriovenous fistula. This study was conducted to investigate the effect of intraoperative systemic heparin on the thrombosis rate and associated morbidities over a duration of six weeks.

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The Effect of Systemic Anticoagulation in Patients Undergoing Angioaccess Surgery

Cited by 24 publications

References 8 publications

Effect of Intra Operative Intravenous Injection of Heparin on Patency Rate of Radio Cephalic Autogenous Arteriovenous-Fistula in Chronic Renal Failure Patients

Effect of Intra Operative Intravenous Injection of Heparin on Patency Rate of Radio Cephalic Autogenous Arteriovenous-Fistula in Chronic Renal Failure Patients

c-Kit signaling determines neointimal hyperplasia in arteriovenous fistulae

Does systemic heparin reduces thrombosis rate of radiocephalic fistula: A double-blinded randomized study

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