Pre-Operative Regional Block Anesthesia Enhances Operative Strategy for Arteriovenous Fistula Creation

Abstract

Vein diameter increases significantly in the basilic and cephalic veins following regional block anesthesia and may improve the rate of native fistula placement. Propensity to dilate after regional block anesthesia does not predict size of the fistula.

Effect of brachial plexus block-driven vascular access planning on primary distal arteriovenous fistula recruitment and outcomes

“…Third, our distal AVF recruitment rate of >44% far exceeds published rates of 3% to 16%. [6][7][8] Follow-up was also complete for all our cases. Last, transposed BB AVFs, which as a result of routine two-staged surgery and longer maturation time in our population, were rightfully excluded to avoid bias.…”

“…Reynolds et al reported an overall modification rate of 17% in a larger cohort of 30 patients operated under supraclavicular BPB. 7 Studied VAs were a mixed group of primary and secondary AVFs as well as AVGs. Only one RC AVF was created out of a total of five plan modifications, resulting in an even lower distal AVF recruitment rate of 3%.…”

“…Alternatively and more simplistically, all cases could have had a preset plans irrespective of primary CV size and then the rate of on-table modification assessed as in previous studies. [6][7][8] However, irrespective of the study design chosen, it is unlikely some elements of bias could be avoided without resorting to randomized controlled trials. The definition of hemodynamic maturation was arbritary although validated, but we did show that switching to other definitions did not change outcomes overall.…”

“…[6][7][8] This hemodynamic boost increases the chances of the draining vein dilating past the 2.5-mm and 4-mm diameter threshold required for successful AVF placement and maturation respectively. 9,10 However, to date, no studies have directly evaluated the benefits of a deliberate on-table BPB-driven and ultrasound-based VA operative planning strategy.…”

Lower Extremity Near-infrared Spectroscopy After Popliteal Block For Orthopaedic Foot Surgery

“…Clinically, patients experience a distinctive albeit subjective sensation of warmth and dilation of the superficial veins. Venodilation in the arm in patients who received an axillary block was demonstrated by echography [ 1 ], and alterations in the ipsilateral brachial artery after brachial plexus block was reported using pulsed wave Doppler ultrasound [ 2 ]. Increased local blood flow and increased skin temperature occur as a result of sympathetic nerve blockade and these neurovascular changes and the resulting local vasodilatation are associated with successful peripheral nerve blockade [ 3 , 4 ].…”