Does anaesthetic technique during AV fistula creation influence long-term successful outcomes?

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The largest randomised controlled trial comparing long-term surgical outcomes between two different anaesthetic techniques, the ACCESs study, has just launched in the UK, to test whether regional, when compared to local, anaesthesia during arteriovenous fistula (AVF) creation will confer greater 12-month unassisted functional patency rates. Other results being assessed are patient-related outcome measures, including a new vascular-access specific quality of life tool being utilised for the first time in a randomised trial. Due to the scale and calibre of the evidence collected, its findings could potentially influence future policy, guidelines and practice.

“Regional anaesthesia naturally causes a sympathetic blockade, vasodilatation and improved blood flow, and it therefore follows and would make sense that that could translate into improved outcomes,” Emma Aitken, chief investigator of the study and a consultant renal transplant surgeon at the Queen Elizabeth University Hospital, Glasgow, UK, tells Renal Interventions.

If regional anaesthesia does prove superior, does it beg the potentially spiky question of whether surgeons should be performing regional blocks? Aitken says it is important to recognise the “significant intricacies” of the procedure, and the expertise anaesthetists have due to the volume of procedures they perform. Still, individual resource challenges might mean some surgeons need to take on the procedure, she says.

UK centres wishing to participate in the trial should contact Emma Aitken via @study_access

This study/project is funded by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) 130567. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

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