INFRACLAVICULAR BLOCK FOR ARTERIOVENOUS FISTULA IN UREMIC PATIENTS

Objective: Arteriovenous fistula (AVF) is an established form of therapy for patients in hemodialysis. The aim of this study is to underline the advantages offered by infraclavicular block during vascular access performance. Methods: From January 2007 to December 2009 thirty-five consecutive consenting patients (W 16; M 19) were included in the study. Demographic data revealed 10 cases of myocardial ischemia (28.6%), 8 cases of chronic obstructive pulmonary disease (22.8%), 22 cases of hypertension (62.8%), 19 cases of diabetes (54.3%). Exclusion criteria were any condition precluding informed consent, infection at the puncture site, known allergy to local anesthetics, pre-existing motor and sensory deficit in the operating limb. Results: Twenty-four patients (68.5%) received a proximal AVF, 11 patients a distal AVF (31.5%). In 22 cases (62.8%) we performed an autogenous AVF; in 13 cases (37.2%) a biological prosthesis was implanted. Only two patients (5.7%) failed to achieve regional block. In the postoperative period no side effects and no generally complications caused by the block were observed. Conclusions: Infraclavicular block or local anesthetic infiltration represents good alternatives to general anesthesia in uremic patients. Arterial and venous dilatation contribute to immediate and long term attainment of high flow in the AVF, which may prevent early failure. Regional techniques in AVF construction yielded also a prolonged duration of action, a shorter maturation time, lower failure rate, higher patency rate, sympathectomy-like effects and improved site selection for AVF creation.