Abstract：
OBJECTIVE: Some studies suggest that regional anesthesia provides better patency for arteriovenous fistula (AVF) for hemodialysis access as compared to local and general anesthesia. This study evaluates the impact of anesthetic modality on long term fistula function at 12 months.
METHODS: A retrospective review of patients undergoing cephalic vein-based hemodialysis access in consecutive cases between 2014 and 2019 was conducted from five safety net hospitals. The primary endpoint was functional patency at 12 months. Subset analysis individually evaluated cephalic-based lower forearm and wrist vs upper arm AVFs. Bivariate and multivariate logistic regression models evaluated the relationship between anesthetic modality and fistula function at 12 months.
RESULTS: There were 818 cephalic-based fistulas created during the study period. The overall 12-month functional patency rate was 78.7%, including an 81.3% patency for upper arm AVF and 73.3% for wrist AVF (P = .009). There was no statistically significant difference among patients with functional and nonfunctional AVFs at 12 months with respect to anesthetic modality when comparing regional, local, and general anesthesia (P = .343). Multivariate regression analysis identified that history of AVF/arteriovenous graft (odds ratio [OR], 0.24; P = .007), receiving intraoperative systemic anticoagulation (OR, 2.49; P < .001), and vein diameter (OR, 1.85; P = .039) as independently associated with AVF functional patency at 12 months.
CONCLUSIONS: There was no association between anesthetic modality and functional patency of cephalic-based AVFs at 12 months. Further studies are needed to better define which patients may benefit from regional anesthesia.
METHODS: A retrospective review of patients undergoing cephalic vein-based hemodialysis access in consecutive cases between 2014 and 2019 was conducted from five safety net hospitals. The primary endpoint was functional patency at 12 months. Subset analysis individually evaluated cephalic-based lower forearm and wrist vs upper arm AVFs. Bivariate and multivariate logistic regression models evaluated the relationship between anesthetic modality and fistula function at 12 months.
RESULTS: There were 818 cephalic-based fistulas created during the study period. The overall 12-month functional patency rate was 78.7%, including an 81.3% patency for upper arm AVF and 73.3% for wrist AVF (P = .009). There was no statistically significant difference among patients with functional and nonfunctional AVFs at 12 months with respect to anesthetic modality when comparing regional, local, and general anesthesia (P = .343). Multivariate regression analysis identified that history of AVF/arteriovenous graft (odds ratio [OR], 0.24; P = .007), receiving intraoperative systemic anticoagulation (OR, 2.49; P < .001), and vein diameter (OR, 1.85; P = .039) as independently associated with AVF functional patency at 12 months.
CONCLUSIONS: There was no association between anesthetic modality and functional patency of cephalic-based AVFs at 12 months. Further studies are needed to better define which patients may benefit from regional anesthesia.
摘要：
目的：一些研究表明，与局部（LA）和全身麻醉（GA）相比，局部（RA）为血液透析（HD）的动静脉瘘（AVF）提供了更好的通畅性。这项研究评估了12个月时麻醉方式对长期瘘功能的影响。
方法：对5家安全网医院在2014年至2019年连续病例中接受基于头静脉的HD患者进行了回顾性回顾。主要终点是12个月时的功能通畅。子集分析分别评估了前臂下部和腕部与上臂AVF的头端。双变量和多变量逻辑回归模型评估了麻醉方式与12个月时瘘功能之间的关系。
结果：在研究期间产生了818个头瘘。总体12个月功能通畅率为78.7%,包括81.3%的上臂AVF通畅率和73.3%的腕部AVF通畅率(p=0.009)。12个月有功能性和非功能性AVF的患者在麻醉方式方面没有统计学上的显著差异，当地,和全身麻醉（p=0.343）。多变量回归分析确定AVF/AVG病史（OR0.24，p=0.007），术中接受全身抗凝治疗（OR2.49，p<0.001），静脉直径（OR1.85，p=0.039）与12个月时的AVF功能通畅独立相关。
结论：在12个月时，麻醉方式与头型AVF的功能通畅之间没有关联。需要进一步的研究来更好地确定哪些患者可能从区域麻醉中受益。
方法：对5家安全网医院在2014年至2019年连续病例中接受基于头静脉的HD患者进行了回顾性回顾。主要终点是12个月时的功能通畅。子集分析分别评估了前臂下部和腕部与上臂AVF的头端。双变量和多变量逻辑回归模型评估了麻醉方式与12个月时瘘功能之间的关系。
结果：在研究期间产生了818个头瘘。总体12个月功能通畅率为78.7%,包括81.3%的上臂AVF通畅率和73.3%的腕部AVF通畅率(p=0.009)。12个月有功能性和非功能性AVF的患者在麻醉方式方面没有统计学上的显著差异，当地,和全身麻醉（p=0.343）。多变量回归分析确定AVF/AVG病史（OR0.24，p=0.007），术中接受全身抗凝治疗（OR2.49，p<0.001），静脉直径（OR1.85，p=0.039）与12个月时的AVF功能通畅独立相关。
结论：在12个月时，麻醉方式与头型AVF的功能通畅之间没有关联。需要进一步的研究来更好地确定哪些患者可能从区域麻醉中受益。
