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Application for ESRA Abstract Prizes: I apply as an Anesthesiologist (Aged 35 years old or less)Background and Aims The use of permanent arteriovenous fistulas provides convenience and comfort for patients who will receive regular dialysis treatment, In some cases, increased vascularity can lead to lateralization of the accessory vessel, resulting in insufficient flow so a second revision operation is performed. These patients have multiple co-morbidities which complicates surgeries, so regional anesthesia can be beneficial. In our case, the patient, who has chronic kidney disease, Alzheimer’s, and heart failure with low cardiac output (ejection fraction 20%) , was scheduled for arterio-venous fistula revision surgery but was non-cooperative. We aimed to present a case where we successfully achieved anesthesia with a brachial plexus block. The revision of an accessory autologous fistula was done.Methods After preoperative monitoring, the PVI (pleth variability index) value was recorded with a Massimo probe, and the diameter of the brachial vein was measured with ultrasound. Using the infraclavicular approach, a brachial plexus block was performed with 25 ml of bupivacaine, and the intercostobrachial nerve was identified in the distal region of the arm, followed by a rescue nerve block with 5 ml of bupivacaine. Within 25 minutes, the initial measurements showed a change in artery diameter from 4.2 mm to 5.1 mm. The patient‘s PVI measurements increased from 2.1 to 3. After performing a pin-prick test, surgery started.Results The 3-hour surgery was completed without complications. At the 21st hour, the artery’s diameter was measured as 2.5 mm. The patient did not require any analgesics overnight.Conclusions Regional anesthesia has become essential, especially in critical high risk patients, with the widespread use of ultrasound. Complications associated with general anesthesia, postoperative opioid uses are minimized. In conclusion, peripheral nerve blocks for anesthesia in high-risk cardiac patients will be safer, more comfortable, and cost-effective