Abstract: FR-PO778
Efficacy of Peri-Vascular Anesthesia in Dialysis Access Procedures – Experience from Saudi Arabia
Session Information
- Hemodialysis: Vascular Access - II
November 03, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Dialysis
- 603 Hemodialysis: Vascular Access
Authors
- Hassan, Danyal, DaVita Saudi Arabia, Jeddah, Saudi Arabia
- Alsuwaida, Abdulkareem, King Saud University, Riyadh, Saudi Arabia
Background
Early and late venous stenosis within a dialysis access is a common complication requiring endovascular intervention. These procedures are typically done under sedation because of pain and discomfort to the patients. On the other hand use of sedation is associated with higher risk of complications.
Methods
We describe the use of peri-vascular local anesthesia (PVA), in a free standing vascular access center (VAC), to treat area of stenosis in dysfunctional dialysis access. The area of the stenosis was identified using standard angiogram and PVA was provided under ultrasound guidance.
The pain experienced by the patients was recorded on a numeric score from 0-10; during the procedure and at the time of discharge. This was then divided into adequate, moderate and poor pain control.
Results
Data was collected for 83 patients who underwent 112 encounters over a period of 15 months. Mean age of the patients was 54 years, with 51% male patients.There were 54 cases of outflow stenosis, 34 inflow stenosis, 10 cases of both inflow and outflow stenosis treated during the same procedure, and 14 thrombectomy cases including 12 AVF thrombectomy and 2 AVG thrombectomy. During procedure 4 covered stents were placed, 2 of them to treat complications.
Overall adequate pain control (0-3) during the procedure was achieved in 91 patients (81%), moderate pain control in 16 patients (14.2%) and poor pain control in 5 patients (4.4%). Post procedure 97% of the patient reported adequate pain control and 3% reported moderate pain control. For thrombectomy procedures 6 (43%) patients reported adequate, 6 (43%) reported moderate and 2 (13%) reported poor pain control. Overall procedure success rate was 98%, with 3 procedures related complications including two Grade I hematomas and one Grade II hematoma. In one case the procedure was stopped due to poor pain control, leading to anxiety, chest pain and transfer to the ER. No PVA related complications were reported except for mild local infiltration and erythema.
Conclusion
In this series, ultrasound guided PVA provided good pain control for endovascular procedures in outpatient setting with minimal complications. In case of thrombectomy, PVA should be decided on case to case basis, due to a higher moderate and poor pain control during the procedure.