Anesthesia Considerations for Upper Extremity Arteriovenous Fistulas

Patients suffering from end-stage renal disease with a glomerular filtration rate (GFR) of <15 ml/min, which is also referred to as stage 5 chronic kidney disease (CKD), and patients with stage 4 CKD with GFR of 15–29 ml/min anticipated to have hemodialysis in the future often require vascular access. Creating a native arteriovenous fistula (AVF) is the most common method for dialysis access and has the best the long-term patency and the least association with morbidity and mortality. These patients commonly present with multiple comorbidities including but not limited to peripheral vascular disease, diabetes, and coronary artery disease, which require consideration on an individual basis. Preoperative medical optimization for these patients can be challenging. Preoperative attention to electrolyte imbalance and volume status can lower perioperative complications. Various options are available for anesthetic management of patients for AVF creation including general anesthesia, regional anesthesia, and local anesthetic infiltration with monitored anesthesia care. In this chapter, we present a brief description of anesthesia considerations for upper extremity AVFs.