Regus Susanne, Almási-Sperling Veronika, Lang Werner
Department of Vascular Surgery, University Hospital, Erlangen - Germany.
J Vasc Access. 2016 Nov 2;17(6):494-498. doi: 10.5301/jva.5000598. Epub 2016 Sep 20.
Arteriovenous fistula (AVF) creation in children could be extremely challenging for vascular surgeons due to small vessels with a high tendency of vasospasm. This could be one reason for primary failures (PF) and early access thrombosis. There exists no guideline for the need of intraoperative heparin administration during hemodialysis fistula creation. The aim of this study was to evaluate the effect of intra-operative heparin administration on immediate outcome.
Medical records of 42 pediatric patients aged between 7 and 17 years were retrospectively reviewed. All received an AVF under inpatient conditions by exclusively one vascular surgeon with many years of professional experience. The intraoperative anticoagulation standards changed by the years 2001 based on the decision of the vascular surgeon. Therefore, we build two groups (group 1: 14 patients with 5000 IU of intravenous heparin during surgery and group 2: 28 patients without heparin). Major complications included hematoma or bleeding leading to surgery. PF was defined as the inability to use the AVF even once due to absent maturation or occlusion within 4 weeks after creation.
We found 6 (14%) PF with the need of immediate surgical access revision (three from group 1 and three from group 2; p = 0.350). There were no bleedings leading to surgery in all cases, but 5 (12%) hematomas without the need of surgical revision (three from group 1 and two from group 2; p = 0.736).
We found no benefit of heparin administration during clamping the arteries while performing the arteriovenous fistula in pediatric patients.
由于血管细小且极易发生血管痉挛，儿童动静脉内瘘（AVF）的创建对血管外科医生来说极具挑战性。这可能是原发性失败（PF）和早期通路血栓形成的原因之一。目前尚无关于血液透析内瘘创建术中是否需要使用肝素的指南。本研究的目的是评估术中使用肝素对即时结果的影响。
回顾性分析了42例年龄在7至17岁之间的儿科患者的病历。所有患者均在住院条件下由同一位拥有多年专业经验的血管外科医生进行AVF手术。根据血管外科医生的决定，2001年起术中抗凝标准发生了变化。因此，我们将患者分为两组（第1组：14例患者在手术期间静脉注射5000 IU肝素；第2组：28例患者未使用肝素）。主要并发症包括血肿或出血导致再次手术。PF定义为由于内瘘成熟不良或在创建后4周内闭塞而无法使用一次AVF。
我们发现6例（14%）PF需要立即进行手术通路修复（第1组3例，第2组3例；p = 0.350）。所有病例均无导致再次手术的出血，但有5例（12%）血肿无需手术修复（第1组3例，第2组2例；p = 0.736）。
我们发现在儿科患者进行动静脉内瘘手术时，夹闭动脉期间使用肝素并无益处。
