BMJ Open (Dec 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
- Philip Bennett,
- Karen Stevenson,
- Marc Clancy,
- Mark Wright,
- Catherine Jardine,
- Sanjay Sinha,
- Cecilia Vindrola-Padros,
- Andrew Jackson,
- Regin Lagaac,
- Rajesh Sivaprakasam,
- Reza Motallebzadeh,
- Gavin Pettigrew,
- Rani Badhan,
- Ramani Moonesinghe,
- Kariem El-Boghdadly,
- Liz Brown,
- James Gilbert,
- Cecilia Vindrola,
- Nikki Dewhirst,
- Rosemary Hogg,
- Darren Morrow,
- Thalakunte Muniraju,
- Alex Vesey,
- Alan Macfarlane,
- David Kingsmore,
- Sheera Sutherland,
- Scott Oliver,
- Alan JR Macfarlane,
- Rachel J Kearns,
- Marc James Clancy,
- Patrick Mark,
- Margaret Aitken,
- Lucian Gaianu,
- Nikolaos Karydis,
- Rita Singh,
- Stuart Suttie,
- Kirsty Wetherall,
- Iain Thomson,
- Vishal Nangalia,
- Emma Aitken,
- Rosie Hogg,
- Andrew Dalton,
- Rose Ross,
- David McNair,
- Linda Stiff,
- Mohammed Tariq Dosani,
- Jennifer Sainsbury,
- Kiran Sran,
- Nadia Castrillo,
- Sarah Crosbie,
- Madita Gavrila,
- Sandra Montgomery,
- Tina McLennan,
- Nina Tarkowska,
- Shelley McLachlan,
- Jonathan de Siqueira,
- Max Troxler,
- Chetan Srinath,
- Vashist Deelchand,
- Gareth Ackland TimEgan,
- Matt Wikner,
- Rachel Kearns,
- Alex MacConnachie,
- Ramani Moonsinghe
Affiliations
- Philip Bennett
- 3Rheumatology and Radiology departments at hospitals at Zealand, Jutland and Funen, Copenhagen, Slagelse, Aarhus, Silkeborg, Odense, Hjørring and Graasten, Denmark
- Karen Stevenson
- Renal Transplant and Vascular Access Surgery, Queen Elizabeth University Hospital, Glasgow, UK
- Marc Clancy
- Mark Wright
- head of real world clinical studies
- Catherine Jardine
- Sanjay Sinha
- 1University of Cambridge, The Lodge, Hertford street, Cambridge, CAM CB4 3AG, UK
- Cecilia Vindrola-Padros
- Department of Targeted Intervention, University College London, London, UK
- Andrew Jackson
- Renal Transplant and Vascular Access Surgery, Queen Elizabeth University Hospital, Glasgow, UK
- Regin Lagaac
- Rajesh Sivaprakasam
- Renal Transplantation, The Royal London Hospital, London, UK
- Reza Motallebzadeh
- Department of Nephrology and Transplantation, Royal Free London NHS Foundation Trust, London, UK
- Gavin Pettigrew
- Department of Surgery, Cambridge University, Cambridge, UK
- Rani Badhan
- Ramani Moonesinghe
- national clinical director for critical and perioperative care
- Kariem El-Boghdadly
- 1 Department of Anaesthesia, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Liz Brown
- James Gilbert
- Cecilia Vindrola
- Nikki Dewhirst
- Rosemary Hogg
- Department of Anaesthesia, Belfast Health and Social Care Trust, Belfast, UK
- Darren Morrow
- Thalakunte Muniraju
- Department of Nephrology, Dumfries and Galloway Acute Hospitals, Dumfries, UK
- Alex Vesey
- Department of Vascular Surgery, University Hospital Hairmyres, East Kilbride, UK
- Alan Macfarlane
- David Kingsmore
- Renal Transplant and Vascular Access Surgery, Queen Elizabeth University Hospital, Glasgow, UK
- Sheera Sutherland
- Scott Oliver
- Alan JR Macfarlane
- Department of Anaesthesia, NHS Greater Glasgow and Clyde, Glasgow, UK
- Rachel J Kearns
- consultant anaesthetist
- Marc James Clancy
- Department of Renal Surgery, Queen Elizabeth University Hospital, Glasgow, UK
- Patrick Mark
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Margaret Aitken
- Department of Renal Surgery, Queen Elizabeth University Hospital, Glasgow, UK
- Lucian Gaianu
- Independent Health Economist, Healthonomics UK Ltd, Reading, UK
- Nikolaos Karydis
- Department of General and Transplant Surgery, University of Patras, Patra, Greece
- Rita Singh
- Department of Anaesthesia, Freeman Hospital, Newcastle upon Tyne, UK
- Stuart Suttie
- Department of Vascular Surgery, NHS Tayside, Dundee, UK
- Kirsty Wetherall
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
- Iain Thomson
- Anaesthetics, Queen Elizabeth University Hospital, GLASGOW, UK
- Vishal Nangalia
- Department of Anaesthesia, Royal Free London NHS Foundation Trust, London, UK
- Emma Aitken
- Renal Transplant and Vascular Access Surgery, Queen Elizabeth University Hospital, Glasgow, UK
- Rosie Hogg
- Andrew Dalton
- Rose Ross
- Department of Respiratory Medicine, NHS Tayside, Dundee, UK
- David McNair
- Linda Stiff
- Mohammed Tariq Dosani
- Jennifer Sainsbury
- Kiran Sran
- Nadia Castrillo
- Sarah Crosbie
- Madita Gavrila
- Sandra Montgomery
- Tina McLennan
- Nina Tarkowska
- Shelley McLachlan
- Jonathan de Siqueira
- Max Troxler
- Chetan Srinath
- Vashist Deelchand
- Gareth Ackland TimEgan
- Matt Wikner
- Rachel Kearns
- Anaesthesia, Critical Care & Peri-operative Medicine Research Group, University of Glasgow, Glasgow, UK
- Alex MacConnachie
- Ramani Moonsinghe
- DOI
- https://doi.org/10.1136/bmjopen-2021-052188
- Journal volume & issue
-
Vol. 11,
no. 12
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.
