{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:20:44Z","timestamp":1787757644106,"version":"build-2784847793"},"reference-count":36,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"vor","delay-in-days":8,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Seminars in Dialysis"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis in patients with end\u2010stage renal disease (ESRD), yet high rates of primary failure and suboptimal patency remain significant challenges. The choice of anesthetic technique may influence vascular dynamics and AVF outcomes. This study aims to compare the effectiveness of regional anesthesia (RA) versus local anesthesia (LA) on clinical outcomes following AVF creation in adults with ESRD. A systematic review and meta\u2010analysis was conducted in accordance with PRISMA 2020 guidelines. PubMed, Cochrane Library, Scopus, and\n                    <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/ClinicalTrials.gov\">ClinicalTrials.gov<\/jats:ext-link>\n                    were searched from inception to November 2025. Randomized controlled trials and comparative observational studies evaluating RA versus LA in adult AVF creation were included. Primary outcomes included primary patency, functional patency, and primary failure rate. Secondary outcomes included complications, re\u2010interventions, anesthesia time, and vascular parameters. Risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) were pooled using a random\u2010effects model where appropriate. Ten studies involving 1920 patients (RA: 949; LA: 971) were included. RA was associated with significantly higher primary patency (RR\u2009=\u20090.93; 95% CI: 0.87\u20130.98;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.01) and lower primary failure rates (RR\u2009=\u20091.47; 95% CI: 1.00\u20132.16;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.05). Complications (RR\u2009=\u20091.49;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.03) and re\u2010interventions (RR\u2009=\u20092.28; p\u2009=\u20090.03) were significantly higher in the LA group. No significant differences were observed in functional patency, anesthesia time, or brachial artery diameter. RA is associated with improved early AVF outcomes, including higher primary patency and reduced failure, complications, and re\u2010interventions, without increasing operative time. These findings suggest that RA may improve early AVF outcomes in selected settings where expertise and resources are available.\n                  <\/jats:p>","DOI":"10.1111\/sdi.70038","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T07:25:26Z","timestamp":1783581926000},"page":"144-156","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Regional vs. Local Anesthesia for Arteriovenous Fistula Creation in Adults With End\u2010Stage Kidney Disease: A Grade Assessed Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-4956-2766","authenticated-orcid":false,"given":"Hammad","family":"Saif","sequence":"first","affiliation":[{"name":"Khyber Medical College  Peshawar Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5580-2372","authenticated-orcid":false,"given":"Salar","family":"Khan","sequence":"additional","affiliation":[{"name":"Ayub Medical College  Abbottabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8949-2343","authenticated-orcid":false,"given":"Muhammad","family":"Shahzaib","sequence":"additional","affiliation":[{"name":"Ayub Medical College  Abbottabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9811-7066","authenticated-orcid":false,"given":"Syed\u00a0Muhammad","family":"Rayyan","sequence":"additional","affiliation":[{"name":"Ayub Medical College  Abbottabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9172-0078","authenticated-orcid":false,"given":"Muhammad","family":"Uzair","sequence":"additional","affiliation":[{"name":"Khyber Medical College  Peshawar Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4800-739X","authenticated-orcid":false,"given":"Mueed","family":"Iqbal","sequence":"additional","affiliation":[{"name":"Ayub Medical College  Abbottabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9485-7046","authenticated-orcid":false,"given":"Bakhtiyar","family":"Ameer","sequence":"additional","affiliation":[{"name":"Ayub Medical College  Abbottabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5570-3094","authenticated-orcid":false,"given":"Hira","family":"Shehzad","sequence":"additional","affiliation":[{"name":"Ayub Medical College  Abbottabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3250-7417","authenticated-orcid":false,"given":"Sarmad","family":"Nazir","sequence":"additional","affiliation":[{"name":"Ayub Medical College  Abbottabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1533-8813","authenticated-orcid":false,"given":"Abdur\u00a0Rehman","family":"Noor","sequence":"additional","affiliation":[{"name":"Ayub Medical College  Abbottabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph18073471"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.14745"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2019111209"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfad040"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2013.08.023"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.299.18.2164"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12871\u2010020\u201001136\u20101"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2017.01.025"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/1745\u20106215\u201014\u2010263"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_11_12_1","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions Version 6.4 (Updated August 2023)","author":"Higgins J. 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E.","year":"2024","journal-title":"Journal of Vascular Surgery"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ultrasmedbio.2006.02.1420"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2009.02.018"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13239-017-0323-0"},{"issue":"4","key":"e_1_2_11_21_1","first-page":"S38","article-title":"The Modifying Effect of General and Regional Anesthesia on the Endocrine\u2010Metabolic Response to Surgery","volume":"7","author":"Kehlet H.","year":"1982","journal-title":"Regional Anesthesia and Pain Medicine"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-198906000-00005"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.egja.2013.12.006"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0000000000000331"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/ACO.0000000000001551"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2019.12.001"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)30948-5"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2010.12.045"},{"issue":"6","key":"e_1_2_11_29_1","first-page":"1038","article-title":"Brachial Plexus Block Versus Local Anesthesia for Arteriovenous Fistula Creation in Patients With End\u2010Stage Renal Disease: A Prospective Randomized Study","volume":"25","author":"Monte I.","year":"2011","journal-title":"Annals of Vascular Surgery"},{"issue":"6","key":"e_1_2_11_30_1","first-page":"365","article-title":"Comparison of Axillary Brachial Plexus Block Versus Local Anesthesia for Arteriovenous Fistula Creation in End\u2010Stage Renal Disease: A Prospective Randomized Study","volume":"59","author":"Meena R. K.","year":"2015","journal-title":"Indian Journal of Anaesthesia"},{"key":"e_1_2_11_31_1","first-page":"58","article-title":"Regional Anesthesia Is Superior to Local Anesthesia for Arteriovenous Fistula Creation","volume":"42","author":"Nofal M. N.","year":"2017","journal-title":"Annals of Vascular Surgery"},{"issue":"2","key":"e_1_2_11_32_1","first-page":"182","article-title":"Brachial Plexus Block for Vascular Access Surgery","volume":"179","author":"Solomonson M. D.","year":"1994","journal-title":"Journal of the American College of Surgeons"},{"issue":"3","key":"e_1_2_11_33_1","first-page":"740","article-title":"Regional Anesthesia for Arm Arteriovenous Fistula Creation May Reduce Perioperative Morbidity","volume":"59","author":"Siracuse J. J.","year":"2014","journal-title":"Journal of Vascular Surgery"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898"},{"key":"e_1_2_11_35_1","volume-title":"The Newcastle\u2013Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta\u2010Analyses","author":"Wells G. 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