Regional vs. Local Anesthesia for Arteriovenous Fistula Creation in Adults With End-Stage Kidney Disease: A Grade...

Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis in patients with end-stage renal disease (ESRD), yet high rates of primary failure and suboptimal patency remain significant challenges. The choice of anesthetic technique may influence vascular dynamics and AVF outcomes. This study aims to compare the effectiveness of regional anesthesia (RA) versus local anesthesia (LA) on clinical outcomes following AVF creation in adults with ESRD. A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 guidelines. PubMed, Cochrane Library, Scopus, and ClinicalTrials.gov were searched from inception to November 2025. Randomized controlled trials and comparative observational studies evaluating RA versus LA in adult AVF creation were included. Primary outcomes included primary patency, functional patency, and primary failure rate. Secondary outcomes included complications, re-interventions, anesthesia time, and vascular parameters. Risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) were pooled using a random-effects model where appropriate. Ten studies involving 1920 patients (RA: 949; LA: 971) were included. RA was associated with significantly higher primary patency (RR = 0.93; 95% CI: 0.87-0.98; p = 0.01) and lower primary failure rates (RR = 1.47; 95% CI: 1.00-2.16; p = 0.05). Complications (RR = 1.49; p = 0.03) and re-interventions (RR = 2.28; p = 0.03) were significantly higher in the LA group. No significant differences were observed in functional patency, anesthesia time, or brachial artery diameter. RA is associated with improved early AVF outcomes, including higher primary patency and reduced failure, complications, and re-interventions, without increasing operative time. These findings suggest that RA may improve early AVF outcomes in selected settings where expertise and resources are available.