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Dialysis Access Surgery: Does Anesthesia Type Affect Maturation and Complication Rates?

Andrew Son1, Kristyn Mannoia1, Anthony Herrera1

  • 1Division of Vascular and Endovascular Surgery, Riverside Department of Surgery, University of California, Riverside County Regional Medical Center, Moreno Valley, CA.

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|March 12, 2016
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Summary
This summary is machine-generated.

Anesthesia type does not significantly impact arteriovenous fistula (AVF) creation success rates, including maturation and complication rates. Monitored anesthesia care with local infiltration may offer efficiency benefits and is recommended for dialysis access surgery.

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Area of Science:

  • Vascular Surgery
  • Anesthesiology
  • Nephrology

Background:

  • Arteriovenous fistula (AVF) creation is the gold standard for long-term dialysis access.
  • Various anesthesia techniques exist, including general endotracheal intubation, laryngeal mask airway, regional anesthesia, and monitored anesthesia care with local infiltration.
  • The impact of anesthesia type on AVF success, defined by complication and maturation rates, remains unclear.

Purpose of the Study:

  • To determine if anesthesia type influences the success rate of arteriovenous fistula creation surgeries.
  • To compare complication and maturation rates across different anesthesia methods used in AVF procedures.

Main Methods:

  • Retrospective review of 253 patients undergoing AVF creation (radiocephalic, brachiocephalic, basilic vein transposition) between 2003-2010.
  • Analysis of three anesthesia types: General Endotracheal Intubation, Laryngeal Mask Airway, and Local Infiltration with Monitored Anesthesia Care.
  • Stratification of demographic data, comorbidities, and risk factors; statistical analysis using ANOVA, chi-squared, and Fisher's exact tests.

Main Results:

  • No statistically significant differences in fistula maturation rates were observed across the three anesthesia types for radiocephalic, brachiocephalic, or basilic vein transposition surgeries.
  • Complication rates did not differ significantly between the surgical procedures and the anesthesia types analyzed.
  • Specific complications analyzed included mortality, myocardial infarction, respiratory insufficiency, venous hypertension, wound infections, neuropathy, and vascular steal syndrome.

Conclusions:

  • Anesthesia type does not significantly affect maturation or complication rates in arteriovenous fistula creation.
  • Monitored anesthesia care with local anesthesia may enhance operative and recovery efficiency.
  • Local anesthesia with monitored anesthesia care is suggested as a preferred method, particularly for patients with comorbidities, potentially avoiding general anesthesia.