Does preemptive stellate ganglion blockage increase the patency of radiocephalic arteriovenous fistula?

OBJECTIVE

Radio-cephalic arteriovenous fistulas (AVFs) have high early failure ratio. Increased sympathetic activity and spasm of radial artery during the surgery may responsible for early occlusion rate.

DESIGN

Fifty patients were randomized to two groups (each containing 25 patients). Stellate Ganglion Blockade (SGB) was performed in Group 1. Another group was considered as control group (Group 2) to make statistical comparisons. All AVFs were performed under local anesthesia in both groups.

RESULTS

Average fistula flow was 201.4+/-40.4 ml/min in Group 1 and 155.6+/-27.4 ml/min in Group 2 (p < 0.001). While average peak velocity of radial artery was 167.1+/-31.3 cm/sec in Group 1, it was 107.8+/-15.8 cm/sec in Group 2 (p < 0.001). Thrill was found in all Group 1 patients, but there was thrill only 13 of the Group 2 patients (p < 0.001). Mean maturation time was 41.4+/-6.8 days after surgery in Group 1 and 77.1+/-10.5 days in Group 2 (p < 0.001). Adequate vascular access was obtained 19 patients in Group 1 and 12 patients in Group 2 (p = 0.041).

CONCLUSION

AVF occlusion rate is much more common in early postoperative period. Diminished sympathetic tonus by preemptive SGB not only increases early patency rate but also increases fistula maturation rate.