Effect of Anesthetic Technique on Early Patency of Radiocephalic Arteriovenous Fistulas in Patients Requiring Hemodialysis.

BACKGROUND

Primary arteriovenous fistula (AVF) remains the vascular access of choice for hemodialysis. However, its widespread use is limited by a significant rate of early failure. The anesthetic technique used during AVF creation may influence maturation and long-term patency, with regional anesthesia (RA) hypothesized to improve outcomes via sympathetic blockade and vasodilation. This study aimed to compare the effects of brachial plexus block (RA) versus general anesthesia (GA) on patency and maturation of radiocephalic AVFs.

METHODS

In this single-center retrospective observational study, 77 adult patients undergoing primary radiocephalic AVF creation between October 2018 and October 2023 were analyzed. The primary outcome was primary unassisted AVF patency at 1 year. Secondary outcomes included assisted primary and secondary patency, time to first cannulation, complication rates, interventions, access-related hospitalizations, and 1-year patient survival.

RESULTS

In the RA group, significantly larger radial artery (2.26 mm vs. 2.19 mm, P = 0.045) and cephalic vein diameters (3.50 mm vs. 3.30 mm, P = 0.005), and higher intraoperative flow rates (214.3 ± 122 ml/min vs. 162.7 ± 54.8 ml/min, P = 0.03) were detected. Delayed AVF closure was less frequent in the RA group (15% vs. 45.2%, P = 1). No significant differences were observed in primary access failure or complication rates.

CONCLUSION

Brachial plexus block RA is associated with improved intraoperative vessel characteristics and significantly lower delayed AVF closure rates compared to GA. These findings support the consideration of RA to optimize AVF outcomes. Prospective randomized studies are needed to confirm these results.