Targeted intraluminal heparinization with flushing in arteriovenous fistula surgery: A practical approach

Background: Early thrombosis is the most common cause of arteriovenous fistula (AVF) failure within the first month after AVF creation. The necessity of heparin use to prevent early thrombosis in AVF surgery is still debated. This study evaluated the effect of the “Targeted Intraluminal Heparinization and Flushing” technique, which provides direct anticoagulation and intraluminal flushing to the fistula vein without requiring additional venous puncture, on early outcomes. Methods: In our clinic, AVF surgeries performed for hemodialysis purposes between 2015 and 2025 were retrospectively evaluated. The 300 patients in the study were divided into three groups based on the intraoperative heparin administration method. Group 1 ( n = 100) consisted of patients who did not receive heparin during AVF creation, Group 2 ( n = 100) consisted of patients who received systemic heparin via a separate venous puncture, and Group 3 ( n = 100) consisted of patients who received intraluminal heparin directly into the target vein before anastomosis. Results: In 300 patients undergoing AVF creation, the early thrombosis rate was 13.3%. Thrombosis rates were 22% in Group 1, 13% in Group 2, and 5% in Group 3, with a statistically significant difference between groups ( p < 0.01). Additionally, pairwise comparisons showed that thrombosis rates were significantly lower in Group 3 than in Groups 1 and 2. Minor bleeding and hematoma rates were 7% in Group 1, 11% in Group 2, and 10% in Group 3, with no significant difference between groups ( p = 0.62). No major bleeding was observed. Conclusion: In AVF surgery, targeted intraluminal heparinization with flushing may improve early AVF patency by reducing thrombosis rates without increasing bleeding complications. Further prospective studies are needed to demonstrate the effectiveness of this approach more clearly.