"Creating an arteriovenous fistula is a small operation on a big patient — the end-stage renal patient carries hyperkalaemia, anaemia, autonomic neuropathy and heart disease into theatre. A well-chosen brachial plexus block sidesteps most of it, provides a sympathectomy that helps the fistula, and protects the airway the patient doesn't need instrumented."
How to use this topic — CritCare.in.Anaesthesia for AV Fistula Creation
The creation of an arteriovenous fistula (radiocephalic "Brescia–Cimino" at the wrist, or brachiocephalic at the elbow) is the commonest vascular-access operation in end-stage renal disease for long-term haemodialysis. It is a short, superficial upper-limb procedure — but performed on a patient with the full burden of chronic kidney disease.
- Optimise the potassium and volume status (dialyse the day before, not immediately before), respect the altered drug handling of renal failure, favour a regional (brachial plexus) block — which also gives a helpful sympathectomy — and protect the fistula arm from cuffs, cannulae and hypotension.
The End-Stage Renal Patient
Hyperkalaemia, anaemia, acidosis, fluid status, uraemic platelet dysfunction, cardiovascular disease & autonomic neuropathy.
🔎02 · ASSESSMENTAssessment & Optimisation
Dialysis timing, checking K⁺ & volume, choosing the arm, and the altered pharmacology of renal failure.
💉03 · RA vs GARegional vs General
Why the brachial plexus block is often preferred (sympathectomy, no airway, analgesia), block choice, and when GA is needed.
🛡️04 · FISTULA CAREIntra-op & Protecting the Fistula
Monitoring, no cuff/IV on the fistula arm, maintaining perfusion, heparin & avoiding hypotension.
🎓05 · PEARLSComplications, Mistakes & References
Steal syndrome, thrombosis, high-output failure, common mistakes, exam pearls and references.