Intraoperative Heparin Use for Upper Extremity Arteriovenous Access Creation Does Not Affect Outcomes
Stephen J. Raulli, Alik Farber, M.D., Mohammad H. Eslami, M.D., Jeffrey A. Kalish, M.D., Douglas W. Jones, M.D., Denis Rybin, Ph.D., Matthew Nuhn, M.D., Amitabh Gautam, M.D., Jeffrey J. Siracuse, M.D..
Boston University, Boston, MA, USA.
Objectives: There is conflicting data about the effect of heparin use on perioperative outcomes during upper extremity arteriovenous (AV) access creation. We assessed the effect of utilization and dose of intraoperative heparin on outcomes in a single-institutional practice.
Methods: All upper extremity AV access cases performed between 2014 and 2017 were reviewed. Patient and procedural details including intraoperative heparin use and dosing as well as protamine use was analyzed. Full heparin dose was defined as 80-100 units per kg and partial heparin was <80 units/kg. Embolic complications, wound hematoma rate, and early patency were evaluated. Multivariable analysis was performed.
Results: 432 AV access cases were identified. These included brachiocephalic (37.5%), brachiobasilic (30.6%), and radiocephalic fistulas (10.6%) as well as AV grafts (16.7%). Average patient age was 64.1 years and 59.5% were male. Full heparinization was used in 20.6%, partial heparinization in 60%, and no heparin was used in 19.4% of cases. Protamine was used in 93.3% of full heparin cases and 40.2% of partial heparin cases. There were no cases of acute thrombosis or distal embolization. Perioperative wound hematoma rate was 4.5% in full heparin, 2.7% in partial heparin, and 1.2% in no heparin cases (P=.42). Access patency at first follow-up was 89.8% for full heparin, 92.9% for partial heparin, and 91.5% for no heparin (P=.63). There was no differences in return to OR or perioperative survival. On multivariable analysis full heparin (OR 4.67, 95% CI .5-43.8, P=.44) and partial heparin (OR 2.31, 95% CI .28-19.4, P=.44) was not associated with hematoma rate. On multivariable analysis full heparin (OR .74, 95% CI .25-2.24, P=.6) and partial heparin (OR 1.29, 95% CI .49-3.36, P=.61) was not associated with patency at follow-up.
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.
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