The Role of Regional versus General Anesthesia on Arteriovenous Fistula and Graft Outcomes: A Single-Institution Experience and Literature Review

Autor: Albert G. Hakaim, W. Andrew Oldenburg, Ruba Sheikh-Ali, Matthew S. Jorgensen, Bradford L.W. James, Christopher B. Robards, Young Erben, Tariq Almerey, Steven R. Clendenen, Zhuo Li, Houssam Farres
Rok vydání: 2020
Předmět:
Adult
Male
Reoperation
Time Factors
Adolescent
medicine.medical_treatment
Arteriovenous fistula
Anesthesia
General
030204 cardiovascular system & hematology
Risk Assessment
030218 nuclear medicine & medical imaging
Blood Vessel Prosthesis Implantation
Young Adult
03 medical and health sciences
Arteriovenous Shunt
Surgical
Postoperative Complications
0302 clinical medicine
Anesthesia
Conduction
Renal Dialysis
Risk Factors
Statistical significance
medicine
Humans
Treatment Failure
Renal Insufficiency
Chronic
Young adult
Vein
Aged
Retrospective Studies
Aged
80 and over
business.industry
Retrospective cohort study
General Medicine
Middle Aged
medicine.disease
Institutional review board
medicine.anatomical_structure
Sympathectomy
Anesthesia
Florida
Female
Surgery
Cardiology and Cardiovascular Medicine
business
Brachial plexus
Zdroj: Annals of Vascular Surgery. 62:287-294
ISSN: 0890-5096
Popis: Background Multiple studies have demonstrated the benefits of creating arteriovenous fistulas (AVFs) under regional anesthesia. This is most likely because of the avoidance of hemodynamic instability and stress response of general anesthesia, as well as the sympathectomy associated with brachial plexus blockade. As vein diameter is the major limiting factor for primary AVF creation and maturation, our aim is to investigate if the vasodilation that accompanies regional anesthesia leads to improved patency and maturation rate of autologous AVF and improved patency of arteriovenous graft (AVG) compared with those placed under general anesthesia. Methods This retrospective study was approved by the institutional review board. A total of 238 patients who had either an AVF or an AVG placed at the Mayo Clinic, Florida, between 2012 and 2017 were analyzed. Demographics, access type, preoperative vein diameter, anesthesia type, change of plan after regional versus general anesthesia, and outcomes were assessed. All statistical tests were 2 sided, with the alpha level set at 0.05 for statistical significance. Results Among 238 patients, 120 (50.4%) had regional anesthesia. Differences between the 2 groups in risk factors and 30-day or long-term outcomes (failure, abandonment, or reoperation) were not statistically significant. Of the accesses placed under general anesthesia, 58.5% were abandoned compared with 45.2% of those placed under regional anesthesia. Owing to loss of patency, 25.8% of accesses placed under general anesthesia were abandoned compared with 19.2% of those placed under regional anesthesia. Two-month failure was higher in the general anesthesia group than that in the regional anesthesia group (P = 0.076). After preoperative vein mapping, 22 patients were originally intended to have an AVG placed under regional anesthesia. After brachial plexus blockade, 9 of these patients (41%) were successfully switched to AVF, while the other 13 followed the original surgical plan and received an AVG. Of these, 0 failed and 0 were abandoned because of loss of patency. Conclusions This study showed possible improvements in failure rates for vascular accesses placed under regional anesthesia compared with those placed under general anesthesia. In addition, we showed an impact of regional anesthesia on the surgical plan by transitioning from a planned AVG to an AVF, intraoperatively. Giving patients with originally inadequate vein diameter the chance to have the preferred hemodialysis access method by simply switching anesthesia type could reduce the number of grafts placed in favor of fistulas.
Databáze: OpenAIRE
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