Abstract: FR-OR046

Does Regional Compared to Local Anaesthesia Influence Outcome after Arteriovenous Fistula Creation? One Year Follow-Up of a Randomised Controlled Trial

Session Information

Category: Dialysis

  • 603 Hemodialysis: Vascular Access

Authors

  • Aitken, Emma L., NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
  • Jackson, Andrew J, NHS Greater Glasgow & Clyde, Glasgow, United Kingdom
  • Kearns, Rachel J, NHS Greater Glasgow & Clyde, Glasgow, United Kingdom
  • Kinsella, John, University of Glasgow, Glasgow, United Kingdom
  • Macfarlane, Alan J, Glasgow Royal Infirmary , Glasgow, United Kingdom
  • Clancy, Marc J., NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
Background

AVF are the optimal form of vascular access but have a high early failure rate. Although regional compared to local anaesthesia produces vasodilation and increases short-term blood flow there is no evidence that anaesthesia modality influences long-term fistula patency. This study investigated whether regional compared to local anaesthesia improved long-term AVF patency. The early (3 month) patency rates were recently published in The Lancet. 1 year follow-up data is now presented.

Methods

An observer-blinded randomised controlled trial was performed at three university hospitals in Glasgow, UK. Adults undergoing primary radiocephalic (RCF) or brachiocephalic (BCF) AVF creation were randomly assigned (1:1; in blocks of eight) using a computer-generated allocation system to receive either local anaesthesia (LA) or regional (brachial plexus block (BPB)) anaesthesia. Patients were excluded if they were coagulopathic, had no suitable vessels or had a previous failed ipsilateral fistula. The primary end point was AVF patency at 3 months. Secondary end points included functional patency at 3 months and 1 year, vessel diameters and brachial artery blood flow before and after anaesthesia (NCT01706354).

Results

163 patients were assessed for eligibility and 126 patients were randomly assigned to LA (n=63) or BPB (n=63). All patients completed follow-up on an intention-to-treat basis. Primary patency at 3 months was higher in the BPB group than the LA group (53 [84%] vs 39 patients [62%]; odds ratio [OR] 3.3, p=0.005) and was greater in RCF (20 [77%] vs 12 patients [48%]; OR 3.6, p=0.03).
In the subsequent year, 18 revisional procedures aimed at improving functional patency were performed on 10 patients. Functional patency at 1 year was higher in the BPB group than the LA group (51 [81%] vs 35 patients [56%]; OR 3.4, p<0.001). This difference remained more marked for RCF than BCF.

Conclusion

BPB significantly improved 3 month primary and functional patency and 12 month functional patency rates. This difference was more marked in RCF. The low early functional patency rates observed in our previously published data are not reproduced in 1 year follow-up data.