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The Health Technology Assessment Programme is accepting stage 1 applications to their commissioned workstream for this primary research topic:
19/25 Anaesthesia for arteriovenous fistula formation
The number of patients reaching end stage renal failure and requiring renal replacement therapy continues to increase year on year with a lack of donor organs leaving many thousands of patients on long-term haemodialysis.
Surgical creation of an arteriovenous fistula (AVF) is the preferred mechanism for renal dialysis vascular access. This surgical procedure joins an artery and a vein in the arm to produce a blood vessel larger and stronger than usual which, once established and fully healed, allows repeated needle puncture for the dialysis to proceed.
The failure rate of AVFs is about 50% at one year, thus any change in practice which might improve AVF patency could make an important difference to patient outcomes and potentially subsequent resource use.
A number of small single centre studies have shown that if regional anaesthesia is used rather than local anaesthesia for the AVF creation procedure, the failure rate is lower. Administration of regional anaesthesia takes longer than that for local and requires a skilled anaesthetist (not required for the local), and thus the up-front costs are higher. However, these could be offset if subsequent patient outcomes are improved and there is a reduced need for re-operation/intervention. A definitive, adequately powered, multi-centre randomised trial with associated cost-effectiveness analysis is therefore proposed to help inform clinical practice.