Efficacy of Regional Anesthesia in Secondary Procedures or Revisions of Arteriovenous Fistula.

BACKGROUND: Several factors affect the outcomes of arteriovenous fistula (AVF) and end-stage renal disease (ESRD). This study aimed to evaluate the efficacy of regional anesthesia in secondary procedures or revisions of AVF. METHODS: Medical records of patients who underwent treatment for AVF secondary procedures or revisions under brachial plexus block (BPB) between March 2016 and June 2019 were retrospectively analyzed. Patient characteristics and clinical outcomes were evaluated. RESULTS: In total, 375 patients (mean age 65.6 ± 12.74; males 210, 56.0%) were enrolled in the study and 770 procedures were performed under BPB for AVF secondary procedures or revisions. The procedures included endovascular treatment (385, 50.0%), surgical treatment (105, 13.6%), and hybrid treatment (280, 36.4%). In 180 procedures (23.4%) for AVF lesions, the operative field included a single segment of the arm, whereas in 590 procedures (76.6%), the operative field included multiple segments. In total, 37 (4.8%) cases of 30-day postoperative complications were observed, of which 33 (4.3%) were surgery-related complications, 2 (0.3%) were BPB-related complications (neurapraxia), and 2 (0.3%) were contrast agent allergic reactions; 34 (4.4%) reinterventions of the total 201 (26.1%) reinterventions were performed within 30 days postoperatively. The mean operation time was 87.5 ± 55.35 min. The pain score for all patients was 0 (no pain), and no patient demanded opioids postoperatively. CONCLUSIONS: Ultrasound-guided BPB is safe and effective for AVF secondary procedures or revisions in ESRD patients.

Simultaneous Hybrid Operation Common Femoral Endarterectomy and Endovascular Treatment in Multilevel Peripheral Arterial Disease with Critical Limb Ischemia.

The purpose of revascularization in lower extremity arterial occlusive disease is to prevent amputation and improve walking ability. Many surgical techniques for peripheral vascular disease (PAD) have been reported. The hybrid operation composed of open surgery and endovascular procedure has been increasingly used for multilevel revascularization. The goal of this study is to evaluate feasibility of simultaneous hybrid femoral endarterectomy and endovascular treatment in patients who need multilevel revascularization with critical limb ischemia. Between March 2011 and July 2014, 38 consecutive patients (43 limbs) with multilevel peripheral arterial disease in critical limb ischemia were treated by simultaneous hybrid operation by single surgeon. The hybrid operation which combines common femoral artery endarterectomy and additive interventional procedure was simultaneously performed for multilevel revascularization. The measurements of primary outcome were primary patency rates, secondary patency rates, and limb salvage rates. Patients who underwent single procedure of surgery or intervention were excluded. The mean age was 72.48 years old and 92.1% were male. The primary and secondary patency rates at 24 months were 67.3 and 72.1%, respectively. The preoperative mean ABI of 0.51 ± 0.27 increased to postoperative mean ABI of 0.88 ± 0.35. The limb salvage rate was 95.3%. Major amputation was performed in 2 out of 43 limbs. There was no early postoperative mortality. The simultaneous hybrid operation for multilevel revascularization may be feasible to treat in multilevel PAD with high technical success and limb salvage rates, thus providing an attractive alternative to larger open surgery or endovascular procedures.