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.
Highlights
According to epidemiological studies, about 10% of patients with chronic renal failure (CRF) undergo renal transplant and the other 90% that do not receive a renal transplantation must remain in dialysis therapy.[1]
Hematoma was not seen in the papaverine group and occurred in one patient in the control group (Table 3, Figure 3)
After Arteriovenous fistula (AVF) creation, shearing stress should be raised in the venous segment
Summary
About 10% of patients with chronic renal failure (CRF) undergo renal transplant and the other 90% that do not receive a renal transplantation must remain in dialysis therapy (hemodialysis or peritoneal dialysis).[1]. Papaverine is an inexpensive, readily available drug with few side effects, and it is an opioid derivative, which relaxes the smooth muscles of the vessel wall This effect is due to inhibition of phosphodiesterase and increase of cyclic adenosine monophosphate (C-AMP).[5, 14] The half-life of this drug is ninety minutes and the drug is metabolized in the liver. 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
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