Tumescent Anesthesia Reduces Pain Associated with Balloon Angioplasty of Hemodialysis Fistulas

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We describe the use of tumescent local anesthesia during endovascular treatment of arteriovenous fistula stenosis. Using ultrasound guidance, 11 patients were hand-injected with tumescent lidocaine anesthesia around the fistula stenosis prior to endovascular therapy. All patients rated the pain experienced during angioplasty on a numeric scale (0-10). The mean balloon inflation pressure was 12 ± 3.01 atm. During angioplasty, eight patients reported pain between 0 and 2; three patients reported 4, 5, and 7 out of 10 on the pain scale. In this small series, tumescent anesthesia provided adequate pain control to perform angioplasty of arteriovenous fistulas.

In the United States there are over 354,000 patients with renal failure on hemodialysis.1 Endovascular therapy of failing arteriovenous fistulas (AVFs) has replaced open surgical revision to prolong the lifespan of the access.2 Balloon angioplasty often requires high inflation pressures resulting in considerable pain. In the hospital setting, intravenous moderate conscious sedation has helped control most of the procedural pain. The degree of conscious sedation is often limited by patients' comorbidities.3 Dilute local anesthesia or “tumescent anesthesia” offers the ability to treat larger areas with reduced toxicity.4 We report our early experience with tumescent local anesthesia during office-based angioplasty of failing hemodialysis access fistulas and grafts.


Presented at the Thirty-fourth Annual Meeting of the Midwestern Vascular Surgical Society, Indianapolis, Ind, September 9-11, 2010.