Improving dialysis access: regional anesthesia improves arteriovenous fistula prevalence.
An autologous arteriovenous (AV) fistula is the preferred form of angioaccess for chronic hemodialysis. A prospective study was carried out to evaluate the potential of regional anesthesia to improve AV fistula prevalence. One hundred ninety-three patients underwent preoperative duplex ultrasound evaluation over a 14-month period. The qualification of each patient to receive either an autologous AV fistula or a prosthetic graft was based on specific sonographic criteria. Patients scheduled for placement of a graft received an ultrasound-directed supraclavicular brachial plexus block, which produces dense sympathetic blockade. After the regional block, those patients who met criteria for primary fistula construction on repeat ultrasound received a fistula instead of a graft. Of 62 patients scheduled to receive an AV graft, 23 or 37 per cent were recruited to receive a fistula instead. The outcome of the recruited fistulas was compared with the 121 planned fistulas. There was no statistically significant difference in primary failure rate (4.3 vs. 5.8%). The recruited fistulas had a shorter average maturation time, 83 +/- 48 versus 132 +/- 82 days (P = 0.023). Within the study population, functioning fistula prevalence was increased from 61.7 to 79.8 per cent. Regional anesthesia and immediate preoperative ultrasound is a useful strategy for increasing fistula prevalence.
Schenk
Worthington G
WG
Department of Surgery, University of Virginia, Charlottesville, Virginia 22908, USA. wgs@virginia.edu
D000765:Anesthesia, Conduction; D001166:Arteriovenous Shunt, Surgical / Q000706:statistics & numerical data; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D011446:Prospective Studies; D006435:Renal Dialysis; D018616:Ultrasonography, Doppler, Duplex