Gholamreza Kazemzadeh1, Ali Saberi1, Reza Manani2, Fatemeh Sadeghipour3, Asghar Rahmani4. 1. Mashhad University of Medical Science, School of Medicine, Mashhad, Iran. 2. Zanjan University of Medical Science, Fellowship of Vascular Surgery, School of Medicine, Zanjan, Iran. 3. Mashhad University of Medical Science, Vascular Surgery Research Center, Mashhad, Iran. 4. Ilam University of Medical Sciences, Iran, Ilam.
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.
RCT Entities:
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.
Authors: Bradley S Dixon; Gerald J Beck; Miguel A Vazquez; Arthur Greenberg; James A Delmez; Michael Allon; Laura M Dember; Jonathan Himmelfarb; Jennifer J Gassman; Tom Greene; Milena K Radeva; Ingemar J Davidson; T Alp Ikizler; Gregory L Braden; Andrew Z Fenves; James S Kaufman; James R Cotton; Kevin J Martin; James W McNeil; Asif Rahman; Jeffery H Lawson; James F Whiting; Bo Hu; Catherine M Meyers; John W Kusek; Harold I Feldman Journal: N Engl J Med Date: 2009-05-21 Impact factor: 91.245
Authors: Laura M Dember; Gerald J Beck; Michael Allon; James A Delmez; Bradley S Dixon; Arthur Greenberg; Jonathan Himmelfarb; Miguel A Vazquez; Jennifer J Gassman; Tom Greene; Milena K Radeva; Gregory L Braden; T Alp Ikizler; Michael V Rocco; Ingemar J Davidson; James S Kaufman; Catherine M Meyers; John W Kusek; Harold I Feldman Journal: JAMA Date: 2008-05-14 Impact factor: 56.272
Authors: Anton N Sidawy; Lawrence M Spergel; Anatole Besarab; Michael Allon; William C Jennings; Frank T Padberg; M Hassan Murad; Victor M Montori; Ann M O'Hare; Keith D Calligaro; Robyn A Macsata; Alan B Lumsden; Enrico Ascher Journal: J Vasc Surg Date: 2008-11 Impact factor: 4.268