Efficacy and comparison of elevation transposition and lipectomy for superficialization of cephalic arteriovenous fistula veins

Abstract

Cephalic elevation transposition and lipectomy are both reliable techniques for superficialization of cephalic fistula veins and their outcomes are comparable.

Intraoperative pneumatic tourniquet use may improve the clinical outcomes of arteriovenous fistula creations

“…11,12,24 Furthermore, tourniquet can also be used to facilitate other arteriovenous access surgeries such as aneurysm repair, forearm prosthetic graft placement, and lipectomy (for superficializing fistula veins). 18,[24][25][26][27] Pneumatic tourniquet is especially helpful for AVF creations in children and patients with small vessel diameters. 9,11,14,16,28,29 The pneumatic tourniquet is a tool readily available in almost all hospital settings and can be acquired at a small cost in outpatient surgery center settings.…”

Liposuction to improve vascular access in hemodialysis patients with arteriovenous fistulas

“…Traditional superficialization procedures used include AVF transposition, AVF vein elevation and direct lipectomy. These procedures typically necessitate longer skin incisions, dissection of the AVF, ligation of side branches, movement of vein impacting angle and torsion of the vessel [6][7][8][9][10][11][12][13][14][15]21 . Liposuction or combination liposuction-minimally invasive lipectomy with incision less than 2 cm offers an alternative to the traditional approaches.…”

“…Obesity increases the difficulty in accessing these fistulas due to presence of excess adipose tissue over the surgically created AVF. This difficulty in cannulation of AVFs may result in fistula infiltration, hematoma or thrombosis formation, and continued requirement of central catheters [5][6][7][8][9][10][11] .…”

“…Up to 33.7% of AVFs may require surgical superficialization to facilitate vascular access. 6 This requires a longer incision and dissection of the AVF, raising the risks of surgical site infection and the wound healing delays time to access in a patient population with other J o u r n a l P r e -p r o o f comorbidities. Other techniques used include fat debulking (lipectomy) using minimal access incisions, liposuction, or both [6][7][8][9][10][11][12][13][14][15] .…”

“…This difficulty in cannulation of the AVF can result in fistula infiltration, hematoma or thrombosis formation, and a continued requirement for central catheters. 5 , 6 , 7 , 8 , 9 , 10 , 11 …”