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Effect of local papaverine on arteriovenous fistula maturation in patients with end-stage renal disease / Efeito da papaverina local na maturação de fístulas arteriovenosas em pacientes com doença renal terminal
Manani, Reza; Kazemzadeh, Gholamreza; Saberi, Ali; Sadeghipour, Fatemeh; Rahmani, Asghar.
  • Manani, Reza; Zanjan University of Medical Science. Fellowship of Vascular Surgery. School of Medicine. Zanjan. IR
  • Kazemzadeh, Gholamreza; Mashhad University of Medical Science. School of Medicine. Mashhad. IR
  • Saberi, Ali; Mashhad University of Medical Science. School of Medicine. Mashhad. IR
  • Sadeghipour, Fatemeh; Mashhad University of Medical Science. Vascular Surgery Research Center. Mashhad. IR
  • Rahmani, Asghar; Ilam University of Medical Sciences. Ilam. IR
J. bras. nefrol ; 41(2): 185-192, Apr.-June 2019. tab, graf
Article in English | LILACS | ID: biblio-1012527
ABSTRACT
Abstract

Background:

Arteriovenous fistula (AVF) maturation is one of the main concerns in patients with end-stage renal disease (ESRD) and finding a strategy for increasing success rate and accelerating fistula maturation is valuable. The aim of this study was to evaluate the effects of papaverine injection on AVF maturation and success rate.

Method:

This study was a randomized clinical trial that involved 110 patients with ESRD that were referred for AVF construction. Patients were allocated in papaverine group and control group with block randomization according to age and sex. In the case group, papaverine (0.1 or 0.2 cc) was injected locally within the subadventitia of artery and vein after proximal and distal control during AVF construction and in the control group, AVF construction was done routinely without papaverine injection.

Results:

Maturation time in case and control groups was 37.94 ± 11.49 and 44.23 ± 9.57 days, respectively (p=0.004). Hematoma was not seen in the case group but occurred in one patient in the control group. One patient of the case group developed venous hypertension. Four functional fistulas, 1 (1.8%) in the case group and 3 (5.5%) in the control group, failed to mature (p=0.618). Maturation rate did not differ between the two groups statistically (p=0.101).

Conclusion:

Local papaverine injection increased vessel diameter and blood flow, increasing shearing stress in both arterial and venous segment of recently created AVF. In this way, papaverine probably can decrease AVF maturation time without an increase in complications.
RESUMO
Resumo

Introdução:

A maturação da fístula arteriovenosa (FAV) é uma das principais preocupações em pacientes com doença renal terminal (DRT). Assim, é importante identificar estratégias para aumentar as taxas de sucesso e acelerar a maturação da fístula. O objetivo do presente estudo foi avaliar os efeitos da infiltração de papaverina sobre a maturação da FAV e suas taxas de sucesso.

Método:

O presente ensaio clínico randomizado incluiu 110 pacientes com DRT encaminhados para colocação de FAV. Os pacientes foram randomizados em bloco em função de idade e sexo e alocados nos grupos caso ou controle. Os indivíduos no grupo caso receberam infiltração local de papaverina (0,1 ou 0,2 ml) no plano da sub-adventícia da artéria e veia após o controle proximal e distal durante a construção da FAV. No grupo controle, a construção da FAV foi realizada rotineiramente sem infiltração de papaverina.

Resultados:

Os tempos de maturação dos grupos caso e controle foram 37,94 ± 11,49 e 44,23 ± 9,57 dias, respectivamente (p = 0,004). Foi observado hematoma em apenas um paciente do grupo controle. Um paciente do grupo caso desenvolveu hipertensão venosa. Quatro fístulas funcionais, uma (1,8%) no grupo caso e três (5,5%) no grupo controle, não amadureceram (p = 0,618). A taxa de maturação não diferiu estatisticamente entre os dois grupos (p = 0,101).

Conclusão:

A infiltração local de papaverina aumentou o diâmetro do vaso e o fluxo sanguíneo, elevando a tensão de cisalhamento nos segmentos arterial e venoso da FAV recentemente criada. Desta forma, a papaverina provavelmente consegue reduzir o tempo de maturação da FAV sem aumentar as complicações.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Papaverine / Vasodilator Agents / Arteriovenous Shunt, Surgical / Kidney Failure, Chronic Type of study: Controlled clinical trial / Etiology study / Observational study / Prognostic study Limits: Adolescent / Adult / Aged / Female / Humans / Male Language: English Journal: J. bras. nefrol Journal subject: Nephrology Year: 2019 Type: Article Affiliation country: Iran Institution/Affiliation country: Ilam University of Medical Sciences/IR / Mashhad University of Medical Science/IR / Zanjan University of Medical Science/IR

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Full text: Available Index: LILACS (Americas) Main subject: Papaverine / Vasodilator Agents / Arteriovenous Shunt, Surgical / Kidney Failure, Chronic Type of study: Controlled clinical trial / Etiology study / Observational study / Prognostic study Limits: Adolescent / Adult / Aged / Female / Humans / Male Language: English Journal: J. bras. nefrol Journal subject: Nephrology Year: 2019 Type: Article Affiliation country: Iran Institution/Affiliation country: Ilam University of Medical Sciences/IR / Mashhad University of Medical Science/IR / Zanjan University of Medical Science/IR