Infraclavicular Brachial Plexus Block for Endovascular Arteriovenous Fistula Creation

Learning Objectives: Describe the technique of infraclavicular brachial plexus block (IBPB) for endovascular arteriovenous fistula (AVF) creations, mechanism of action, reported efficacies, complication rates, and limitations.

Background: Intra-operative ultrasound BPB is regarded as the gold-standard method for providing anesthesia for creating AVF for hemodialysis access {1}. Blind techniques and neurostimulation associated with a high complication incidence, were previously used {2}. Many block approaches have emerged, including axillary, supraclavicular and infraclavicular {2}. This review discusses IBPB for endovascular AVF creation, the mechanism of action, reported efficacies, complication rates, and limitations.

Clinical Findings/Procedure Details: The exhibit will (1) highlight the technique, vascular and iatrogenic complications reported for this procedure, (2) provide an honorable mention of the efficacy and limitations of the procedure in comparison with other types of BPB, mainly to understand if one could be used rather than the other for local causes (3) present the current literature on the use of IBPB for endovascular AVF Creation, the study limitations, and future research considerations.

Conclusion and/or Teaching Points: An Interventional Radiologist performing IBPB, particularly for Endovascular AVF Creation, requires in depth understanding of the technique, associated adverse events and limitations, and patient discomfort and satisfaction with this procedure. This exhibit reviews the literature on this procedure. It highlights the need for future studies to be conducted while ensuring satisfactory anesthesia and postoperative analgesia are established to increase the available data on the procedure performed for practice improvement.