Prospective Cohort Study on the Long-term Impact of Intraoperative Heparin in Radiocephalic Arteriovenous Fistulas

Short-term randomized trials suggest that intraoperative systemic heparin improves arteriovenous fistula (AVF) patency, but long-term outcomes remain unclear. This study reports the five-year follow-up of a previously published double-blinded randomized trial on systemic heparin during AVF creation.

Eighty-eight patients from the original trial (July 2015–July 2016) were included, equally randomized into the heparin and control groups. Long-term outcomes (July 2016–July 2022) were obtained from electronic hospital records, dialysis centers, and telephone follow-up. Primary endpoints were AVF patency, secondary interventions, mortality, and renal transplantation.

Seventy-two patients were available for final analysis. The median age was 57.5 years. Primary patency was superior in the heparin group during the first two years, with borderline significance at year 1 (p-value = 0.06) and statistical significance at year 2 (p-value = 0.019). Beyond year 2, no significant differences were observed. Mortality was higher in the control group (12 vs. 9 deaths), with cardiac events accounting for 32% of all deaths. Secondary interventions were more frequent in the control group, although the difference was not statistically significant.

Intraoperative systemic heparin demonstrated a clear benefit in early AVF patency, which may improve uninterrupted dialysis access in patients with end-stage renal failure. However, the effect diminished after two years, and long-term outcomes were influenced by mortality and loss to follow-up.

Systemic heparin improves primary AVF patency during the first two years, supporting its role in early access preservation. Larger multicenter studies are warranted to validate these findings.