Anaesthesia Choice for Creation of Arteriovenous Fistula (ACCess) study protocol: a randomised controlled trial comparing primary unassisted patency at 1 year of primary arteriovenous fistulae created under regional compared to local anaesthesia

Macfarlane, A. J.R. et al. (2021) Anaesthesia Choice for Creation of Arteriovenous Fistula (ACCess) study protocol: a randomised controlled trial comparing primary unassisted patency at 1 year of primary arteriovenous fistulae created under regional compared to local anaesthesia. BMJ Open, 11(12), e052188. (doi: 10.1136/bmjopen-2021-052188) (PMID:34937718) (PMCID:PMC8704953)

Abstract

Introduction: Arteriovenous fistulae (AVF) are the ‘gold standard’ vascular access for haemodialysis. Universal usage is limited, however, by a high early failure rate. Several small, single-centre studies have demonstrated better early patency rates for AVF created under regional anaesthesia (RA) compared with local anaesthesia (LA). The mechanistic hypothesis is that the sympathetic blockade associated with RA causes vasodilatation and increased blood flow through the new AVF. Despite this, considerable variation in practice exists in the UK. A high-quality, adequately powered, multicentre randomised controlled trial (RCT) is required to definitively inform practice. Methods and analysis: The Anaesthesia Choice for Creation of Arteriovenous Fistula (ACCess) study is a multicentre, observer-blinded RCT comparing primary radiocephalic/brachiocephalic AVF created under regional versus LA. The primary outcome is primary unassisted AVF patency at 1 year. Access-specific (eg, stenosis/thrombosis), patient-specific (including health-related quality of life) and safety secondary outcomes will be evaluated. Health economic analysis will also be undertaken. Ethics and dissemination: The ACCess study has been approved by the West of Scotland Research and ethics committee number 3 (20/WS/0178). Results will be published in open-access peer-reviewed journals within 12 months of completion of the trial. We will also present our findings at key national and international renal and anaesthetic meetings, and support dissemination of trial outcomes via renal patient groups. Trial registration number: ISRCTN14153938. Sponsor: NHS Greater Glasgow and Clyde GN19RE456, Protocol V.1.3 (8 May 2021), REC/IRAS ID: 290482.

• Item Type: Articles
• Additional Information: This work is supported by National Institute for Health Research (NIHR) (Health Technology Assessment 130 567).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: McConnachie, Professor Alex and Aitken, Dr Emma and Kingsmore, Prof David and Mark, Professor Patrick and Kearns, Dr Rachel and Wetherall, Miss Kirsty and MacFarlane, Dr Alan and Stevenson, Dr Karen and Clancy, Mr Marc
• Authors: Macfarlane, A. J.R., Kearns, R. J., Clancy, M. J., Kingsmore, D., Stevenson, K., Jackson, A., Mark, P., Aitken, M., Moonesinghe, R., Vindrola-Padros, C., Gaianu, L., Pettigrew, G., Motallebzadeh, R., Karydis, N., Vesey, A., Singh, R., Muniraju, T., Suttie, S., McConnachie, A., Wetherall, K., El-Boghdadly, K., Hogg, R., Thomson, I., Nangalia, V., Aitken, E., Pettigrew, G., Lagaac, R., Hogg, R., Suttie, S., Dalton, A., Bell, S., Ross, R., Muniraju, T., McNair, D., Stiff, L., Jardine, C., Singh, R., Dosani, M. T., Sainsbury, J., Karydis, N., Sran, K., El-Boghdadly, K., Castrillo, N., Gilbert, J., Sinha, S., Sutherland, S., Crosbie, S., Gavrila, M., Vesey, A., Montgomery, S., McLennan, T., Tarkowska, N., Oliver, S., Brown, L., McLachlan, S., de Siqueira, J., Troxler, M., Dewhirst, N., Wright, M., Srinath, C., Bennett, P., Morrow, D., Aitken, E., Clancy, M., Thomson, I., Jackson, A., Stevenson, K., Kingsmore, D., Aitken, M., Motallebzadeh, R., Nangalia, V., Deelchand, V., Badhan, R., Sivaprakasam, R., TimEgan, G. A., Wikner, M., Macfarlane, A., Kearns, R., Gaianu, L., MacConnachie, A., Wetherall, K., Mark, P., Moonsinghe, R., and Vindrola, C.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: BMJ Open
• Publisher: BMJ Publishing Group
• ISSN: 2044-6055
• ISSN (Online): 2044-6055
• Published Online: 22 December 2021
• Copyright Holders: Copyright © 2021 The Authors
• First Published: First published in BMJ Open 11(12): e052188
• Publisher Policy: Reproduced under a Creative Commons License