Recommended by the KDOQI vascular access guidelines, antebrachial arteriovenous fistula is the best primary vascular access for hemodialysis in patients with end stage renal disease. The primary complications are common, of the order of 10-36 %, including lack of maturation and dominated by stenosis and thrombosis. Local anesthesia associated with sedation is a validated method of anesthesia for made arteriovenous fistula but does not cause the motor block and not blocking vasospasm, deleterious to the surgery. Multiple injections necessary to cover the operating zone expose patient to pain and to intravascular injection of local anesthetics. Regional anesthesia provides better conditions for realize more distal fistula. Sympathetic block provides arterial, venous vasodilation and decreases the incidence of vasospasm . It enables an increased flow rate at an early time fistula and faster maturation. However, studies included low numbers of patient or are non-randomized. They cannot concluded a significant difference in the complication rate of arteriovenous fistula at an early time depending on the type of anesthesia . This study aims to demonstrate that axillary block for surgical creation of arteriovenous fistula allows a reduction of complications at 6 weeks compared to local anesthesia
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
NONE
Enrollment
78
Axillary brachial plexus block anesthesia with injection of Ropivacaine and Lidocaine will be performed by anesthetist 30 to 45 minutes before surgery
Local subcutaneous infiltration of Ropivacaine and Lidocaine will be performed by anesthetist at the beginning of surgery
Hopital Edouard Herriot - Service Anesthésie et Réanimation
Lyon, France
Rate of early complications related to arteriovenous fistula regardless of type
Early complications include stenosis of arteriovenous fistula, thrombosis, lack of maturation, high flow, clinical steal syndrome, arteriovenous fistula infection, arteriovenous fistula hemorrhage, necessity of radiologic ou surgical reintervention,
Time frame: 6 weeks after surgery
Rate of complications related to arteriovenous fistula regardless of type
Complications included stenosis of arteriovenous fistula, thrombosis, lack of maturation, high flow, clinical steal syndrome, arteriovenous fistula infection, arteriovenous fistula hemorrhage, necessity of radiologic ou surgical reintervention.
Time frame: 3 months after surgery
Rate of stenosis of arteriovenous fistula
stenosis of arteriovenous fistula : resistance index \> 0.6, or peak velocity \> 300 cm/s and residual diameter \<3 mm
Time frame: 6 weeks after surgery
rate of thrombosis
thrombosis: resistance index = 1
Time frame: 6 weeks after surgery
incidence of abnormal arteriovenous fistula rate
abnormal arteriovenous fistula rate : lack of maturation (blood flow \< 600 ml/min) or high flow (clinical heart failure, blood flow \> 1200 ml/min)
Time frame: 6 weeks after surgery
incidence of clinical steal syndrome
clinical steal syndrome : trophic or neurological disorders
Time frame: 6 weeks after surgery
incidence of arteriovenous fistula infection
Time frame: 6 weeks after surgery
incidence of arteriovenous fistula hemorrhage
arteriovenous fistula hemorrhage : spontaneous bleeding, post-puncture bleeding
Time frame: 6 weeks after surgery
necessity of radiologic ou surgical reintervention
Time frame: 6 weeks after surgery
Rate of stenosis of arteriovenous fistula
stenosis of arteriovenous fistula : resistance index \> 0.6, or peak velocity \> 300 cm/s and residual diameter \<3 mm
Time frame: 3 months after surgery
rate of thrombosis
thrombosis: resistance index = 1
Time frame: 3 months after surgery
incidence of abnormal arteriovenous fistula rate
abnormal arteriovenous fistula rate : lack of maturation (blood flow \< 600 ml/min) or high flow (clinical heart failure, blood flow \> 1200 ml/min)
Time frame: 3 months after surgery
incidence of clinical steal syndrome
clinical steal syndrome : trophic or neurological disorders
Time frame: 3 months after surgery
incidence of arteriovenous fistula infection
Time frame: 3 months after surgery
incidence of arteriovenous fistula hemorrhage
arteriovenous fistula hemorrhage : spontaneous bleeding, post-puncture bleeding
Time frame: 3 months after surgery
necessity of radiologic ou surgical reintervention
Time frame: 3 months after surgery
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