The importance of anesthesiological methods in the creation of arteriovenous fistulas


  • Radojica V. Stolić University of Kragujevac, Serbia, Faculty of Medical Sciences, Department of Internal Medicine, Serbia
  • Snezana Markovic-Jovanovic University of Pristina/K.Mitrovica, Serbia, Medical Faculty Pristina/K.Mitrovica, Serbia
  • Vladan Perić University of Pristina/K.Mitrovica, Serbia, Medical Faculty Pristina/K.Mitrovica, Serbia
  • Vekoslav Mitrović University of East Sarajevo, Faculty of Medicine Foca, Republika Srpska, Bosnia and Herzegovina
  • Goran Relić University of Pristina/K.Mitrovica, Serbia, Medical Faculty Pristina/K.Mitrovica, Serbia
  • Kristina Bulatović University of Pristina/K.Mitrovica, Serbia, Medical Faculty Pristina/K.Mitrovica, Serbia
  • Saša Sovtić University of Pristina/K.Mitrovica, Serbia, Medical Faculty Pristina/K.Mitrovica, Serbia
  • Branka Mitić University of Niš, Serbia, Faculty of Medicine, Serbia



Anesthesiology, Arteriovenous fistula, Local anesthesia, Regional block anesthesia, General anesthesia


All anesthesia procedures represent a real danger to life in patients with renal insufficiency, which is why these patients are classified in category IV, so anesthesia procedures for this population are adjusted depending on their individual characteristics. Although local and general anesthesia are acceptable modalities for arteriovenous fistula formation, it is known that local anesthesia is associated with tissue reduction and edema, which may be associated with reduced electrocautery efficiency, increased risk of infection, and vasospasm, especially with repeated injections. It must be noted that there is no consensus on whether an arteriovenous fistula should be created under local, regional, or general anesthesia. Still, it is considered that regional block anesthesia provides reduced vasospasm of blood vessels, provokes venodilatation and complete sensory and blockade of motor neurons, as well as higher primary functional rates in the first 3 months, since its creation, compared with local anesthesia. Overall, patients with end-stage renal disease are a group of patients with a wide range of comorbidities which, along with chronic kidney damage, increase the risk of perioperative anesthetic complications, especially when subjected to general anesthesia. Therefore, alternative modes of anesthesia, such as local and regional blockade, could bring obvious benefits to these patients. It can be concluded that the choice of anesthesia method is determined by several interrelated factors, anesthesiologist, patient and the surgeon, which implies expertise, inclination, habits, practicality, and norms.


Stolic R. Most Important Chronic Complications of Arteriovenous Fistulas for Hemodialysis. Med Principles Pract. 2013;22:220-28.

Stolic R, Grbic R, Odalovic D, Smilic L. Hemodynamic changes conditioned by arteriovenous fistulas for hemodialysis. Ital J Vasc Endovasc. 2015;22(3):153-8.

Stolic R, Trajkovic G, Kostic M, Lazic B, Odalovic B, Smilic T et al. Cannulation Technique and Arteriovenous Fistula Survival in Elderly Patients on Hemodialysis. Nephrol Nurs J. 2017;44(5):441-46.

Stolic R, Trajkovic G, Kostic M, Mihailovic B, Jovanovic A, Lazic B, et al. Factors affecting the patency of arteriovenous fistulas for hemodialysis: Single center experience. Hemodialisys International. 2018;22:328-34.

Stolić R. Dysfunction of the arteriovenous fistula for hemodialysis as a consequence of venous neointimal hyperplasia and treatment strategies. Srp Arh Celok Lek. 2019;147 (9-10):642-48.

Cerneviciute R, Sahebally SM, Ahmed K, Murphy M, Mahmood W, Walsh SR. Regional Versus Local Anaesthesia for Haemodialysis Arteriovenous Fistula Formation: A Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg. 2017;53:734e742.

Ramirez MP, Berman SS. Anesthetic Considerations. In: Berman SS, eds.Vascular access in clinical practice. Tucson, Arizona. 2002:15-31.

Elsharawy MA, Al-metwalli R. Does regional anesthesia influence early outcome of upper arm arteriovenous fistula? Saudi J Kidney Dis Transpl. 2010;21:1048-52.

Bradley T, Teare T, Milner Q. Anaesthetic management of patients requiring vascular access surgery for renal dialysis. BJA Education. 2017;17(8):269-74.

ReynoldsTS, Kim KM, Dukkipati R, Nguyen TH, Julka I, Kakazu C, et al. Pre-operative regional block anesthesia enhances operative strategy for arteriovenous fistula creation. J Vasc Access. 2011;12(4):336-40.

Aitken E, Jackson A, Kearns R, Steven M, Kinsella J, Clancy M, et al. Effect of regional versus local anaesthesia on outcome after arteriovenous fistula creation: a randomised controlled trial. Lancet. 2016;388:1067e74.

Mouquet C, Bitker MO, Bailliart O, Rottembourg J, Clergue F, Montejo LS, et al. Anesthesia for creation of a forearm fistula in patients with endstage renal failure. Anesthesiology. 1989;70(6):909e14.

Shoshiashvili V, Tataradze A, Beglarishvili L, Managadze L, Chkhotua A. Influence of type of anesthesia on hemodynamic parameters and outcome of dialysis arteriovenous fistula operations. Georgian Med News. 2015;249:20e7.

Armstrong RA, Wilson C, Elliott L, Fielding CA, Rogers CA, Caskey FJ, et al. Regional anaesthesia practice for arteriovenous fistula formation surgery. Anaesthesia. 2020;75(5):626-33.

de Jong RH, Robles R, Corbin R. Central actions of lidocaine synaptic transmission. Anesthesiology. 1969;30:19.

Solomonson MD, Johnson ME, Ilstrup D. Risk factors in patients having surgery to create an arteriovenous fistula. Anesthesia and Analgesia. 1994;79:694-00.

Madison SJ, Alkire MT. Anaesthesia for vascular access surgery. In: Wilson SE, eds. Essentials of vascular access 1st edition. Inchinnan, Scotland, UK.






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