Effect of General Anesthesia Versus Regional Brachial Plexus Block on Patency of Vascular Access for Hemodialysis

Abstract

Primary arteriovenous fistula (AVF) remains the best vascular access for hemodialysis since it has the best long-term primary patency rate, requires less interventions/maintenance, and has the lowest incidence of morbidity and mortality. For this reason, the National Kidney Foundation began the “Fistula First Breakthrough Initiative”, which seeks to increase the amount of successful AVFs placed. Multiple factors play a role in primary AVFs creation; Vein diameter/quality, artery diameter/quality, central venous disease, hypercoagulable states and fistula location. Multiple studies have demonstrated the benefits of creating AVFs under regional anesthesia; Avoiding hemodynamic instability and stress response of general anesthesia and vasodilatation cause and effects. Due to the fact that vein diameter is the major limiting factor for primary AVFs creation and maturation, our aim is to investigate if the vasodilation that accompanies regional anesthesia leads to improved patency and maturation rate of autologous AVF and graft.