Safety of Reduced‒ or No‒heparin Strategies during Percutaneous Transluminal Angioplasty for Vascular Access

Abstract

Objective： This retrospective study aimed to evaluate the safety and clinical utility of reduced‒ or no‒heparin strategies during percutaneous transluminal angioplasty (PTA) for vascular access by comparing them with a conventional full‒dose heparin protocol. Methods： We analyzed cases of PTA performed between 2014 and 2023, comparing rates of major vascular rupture (defined as cases requiring surgical intervention, including surgical closure due to irreparable rupture) between the conventional heparin protocol period (2014‒2018) and reduced‒ or no‒heparin strategy period (2019‒2023). We also assessed intraoperative thrombosis and 6‒month primary patency between the heparin and non‒heparin groups. Multivariable logistic regression was used to identify independent factors associated with heparin administration. Results： Compared with the heparin group, adoption of the reduced‒ or no‒heparin strategy was correlated with a significant decrease in the incidence of major vascular rupture (11 vs. 2 cases, respectively, p ＝0.010). There were no significant differences in short‒term occlusion rates or 6‒month primary patency between the heparin and non‒heparin groups, and no clinically problematic thrombosis occurred. Key factors associated with heparin use included： arteriovenous graft (AVG), chronic total occlusion (CTO), and vascular spasm. When heparin was administered, the median dose was low, at 500 units (IQR： 300‒800). Conclusion： Systemic heparin administration may not be mandatory for PTA. The reduced‒ or no‒heparin strategy significantly lowers the risk of major vascular rupture while maintaining short‒ and mid‒term patency. Key elements facilitating this safe approach include the： short procedural duration, real‒time ultrasound guidance, and rapid team‒based management of thrombosis.