Pediatric patients undergoing arteriovenous fistula surgery without intraoperative heparin.

Introduction: 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.

Methods: 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.

Results: 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).

Conclusions: We found no benefit of heparin administration during clamping the arteries while performing the arteriovenous fistula in pediatric patients.