Stellate ganglion light irradiation to enhance vasodilation in arteriovenous fistula creation for hemodialysis

Abstract

Background: Achieving functional arteriovenous fistulas (AVFs) with sustained patency in chronic kidney disease (CKD) patients remains challenging. Preoperative vessel diameter and early postoperative blood flow are key determinants of AVF maturation. While regional anesthesia promotes vasodilation, it carries procedural risks and requires specialized expertise. Stellate ganglion light irradiation (SG-LI) using near-infrared light (NIR) is a minimally invasive alternative for vasodilation. We evaluated the safety, feasibility, and vasodilatory effects of SG-LI for AVF creation in CKD patients.

Methods: This pilot study was prospectively registered (jRCT1032230550) and enrolled adult CKD patients scheduled for elective AVF creation at Kameda Medical Center in Japan between January and March 2024. SG-LI was performed preoperatively using a near-infrared therapy device. Ultrasound measured vessel diameters before and after SG-LI. The primary outcome was the diameter change in cephalic vein. Secondary outcomes included diameter changes in the median cubital vein, communicating vein, radial artery, and brachial artery. Adverse events and AVF patency at one and six months were also assessed.

Results: SG-LI significantly increased vessel diameters in the cephalic vein (0.29 ± 0.23 mm, p = 0.034), median cubital vein (1.06 ± 0.80 mm, p = 0.002), and brachial artery (0.22 ± 0.27 mm, p = 0.034). No significant changes were observed in the radial artery (0.09 ± 0.16 mm, p = 0.108) or communicating vein ( - 0.014 ± 0.45 mm, p = 0.613). No adverse events occurred. AVF patency was 100% at one and six months.

Conclusions: SG-LI is a safe, feasible, and minimally invasive modality that induces vasodilation in CKD patients. It may offer an alternative to regional anesthesia for AVF creation.

Trial registration: This study was prospectively registered on Japan Registry of Clinical Trials (jRCT1032230550).

Keywords: AV fistula; Chronic Kidney Disease; Hemodialysis; Infrared irradiation; Peripheral nerve block; Regional anesthesia; Stellate ganglion.