Medical Journal of The Islamic Republic of Iran (MJIRI)

 Abstract

 Background: Thrombosis will occur due to contact of blood with unepithelialized surfaces after vascular clamping and also blood stasis during vascular surgery. Heparin is administered to prevent thrombosis. The aPTT test is used for assurance of the anticoagulative effect of heparin. At the end of the operation heparin is neutralized by protamine sulfate in some centers. In this study we assessed the necessity of aPTT and the use of protamine during vascular surgery.

 Methods: In this case-control survey 154 cases of vascular surgery were divided in to two groups, while the groups were matched regarding age, underlying disease and for vascular complications during the first postoperative 24 hours. In group A (62 cases), aPTT was determined after 2 minutes of heparin administration but heparin was not neutralized by protamine at the end of the operation. In group B (92 cases), aPTT was not determined after heparin administration but heparin was neutralized by an appropriate dose of protamine at the end of the operation.

 Results: Complications were seen in 4 cases of vascular surgery (2.6 %): right leg embolus in 1 case (0.65 %), spinal ischemia in 1 case (0.65 %), neuropathy in 1 case (0.6%) and hypotension due to protamine in 1 case (0.65 %). 3 cases were from group Aand 1 case was from group B, but differences were not statistically significant although the power is high enough (power=70%).

 Conclusion: According to our findings it seems with appropriate techniques and accomplishing surgical principles, there is no need for aPTT assessment and protamine administration. This can reduce the cost and duration of operation, its complications, and prevent adverse reactions to protamine.

  Background : Chronic Kidney Disease (CKD) is a complicated kidney problem causing permanent renal failure in progressive stages. The final stage of CKD is called ESRD in which most accepted management is Hemodialysis (HD). Arterio-Venus Fistula (AVF) is the most practical way of making proper access to the blood circulatory system however, maturation of the AVF is a challenge, since there are number of variables interfering with the whole process. The purpose of this study was to evaluate potentially modifiable factors associated with Maturation Time (MT) after creation of a Vascular Access (VA).

  Methods : In this cross-sectional study, a total of 87 patients referred to the Hasheminejad Kidney Center for AVF creation in 2010 were evaluated. Patients were evaluated before and after the AVF creation and risk factors such as history of blood pressure abnormalities, diabetes and congestive heart failure, as well as the successive development of AVF was studied and finally processed using ‘data mining’ technology.

  Results : The “Decision Trees” indicated the significant impact of the systolic blood pressure (SBP) in the delay of the patient’s AVF maturation. Also, prediction of AVF maturation was made with 70.59% of precision in regard to their BP condition.

  Conclusion : This study demonstrated that monitoring the SBP is one of the important steps in management of the cardiovascular variables producing any delay in the process of the patient’s HD. Also the data mining method can discover the hidden relationship between the patient’s medical conditions in order to predict the potential disorders.