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

ABSTRACT

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.