SAT-048 IMPACT OF ANAESTHESIA ON PROSPECTIVE OUTCOMES AFTER THE CREATION OF ARTERIOVENOUS FISTULA

Abstract

The burden of patients requiring venous access to facilitate haemodialysis is well known. The preferred surgical access is the creation of a native arteriovenous fistula (AVF). However, these fistulae are known to have high early failure rates. The type of anaesthesia provided during this surgery may influence outcomes. No definitive studies have examined the difference that general anaesthesia (GA) compared to regional anaesthesia in the form of a brachial plexus block (BPB) may have on AVF patency rates. Ethical approval was obtained for this multicentre prospective observational study comparing 6 week radiocephalic (RC) AVF primary patency amongst patients receiving GA vs. BPB. Patients were excluded if they received local anaesthetic infiltration or surgery to concurrent parts of the body or any other vascular access procedure. 8 centres participated. 168 patients were identified. 6 week RC AVF primary patency rate was 89% (95% confidence interval 83-95%) in the BPB group (n=99) compared to 75% (95% confidence interval 65-85%) in the GA group (n=69). There were more obese patients in the BPB group (43%+/-10% vs. 22%+/-10%, p<0.01) and more females in the BPB group (38%+/-10% vs. 22%+/-10%, p=0.03). Operative time was longer in the BPB group than the GA group (median values in minutes: 120 (IQR 35) vs. 105 (IQR 33), p<0.01, respectively). There is a signal that administering a brachial plexus block for the creation of a AVF confers a higher radiocephalic AVF patency rate compared to general anaesthesia. This is apparent even though more patients in the BPB had risk factors that are associated with lower patency rates (obesity and female sex). This needs to be examined further. A multicentre randomised clinical trial comparing BPB to GA is being planned to assess the impact of anaesthesia technique on AVF patency.