Liposuction used to treat deep vascular accesses for hemodialysis

Abstract

Background: Oftentimes, obese dialysis patients develop a viable dialysis access but the access is too deep for cannulation and needs a superficialization procedure. Methods: We present our 14-patient cohort in whom we performed liposuction to superficialize viable but deep vascular accesses. Out of 14 patients, 12 had arteriovenous fistulas and 2 arteriovenous grafts. The primary end points were the ability to superficialize a completely unusable access and to remove the hemodialysis catheter (3patients), or to significantly extend the useful length of a deep access in which only a very short segment was used and to continue to use the access post-surgery without the need to place a dialysis catheter (11 patients). Results: The study goal was met in 13 out of 14 patients. In two of three patients, the catheters were removed and their access usable length was 14 and 13 cm, respectively. The accesses could be used immediately after liposuction in all patients in which this applied—11 patients. The usable access length increased from a mean of 5 to 12.7 cm. The access mean depth decreased from 10.8 mm pre-surgery to 7 mm post-surgery and 5.3 mm 4 weeks after surgery. The mean volume of fat removed was 43.8 cc. We had only one surgical complication: bleeding that was readily controlled with manual pressure. All patients were discharged to home the same day. Postoperative pain was mild. Conclusion: Liposuction is effective, safe, and seems to be the least invasive technique of superficialization.

Liposuction to improve vascular access in hemodialysis patients with arteriovenous fistulas

“…A significant benefit of the liposuction technique is less tissue dissection, smaller incisions, lower risk of wound healing complications, and potentially faster recovery. Previous case reports and smaller cohort studies have reported liposuction to be an effective and welltolerated technique with a lower complication profile [8][9]11,[16][17][18] . Our cohort's findings are reflective of this, as AVF cannulation was successful in 79% of patients, with minor complications that were medically managed.…”

“…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] .…”

“…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] .…”

“…The procedure requires smaller incisions, can be performed under light sedation and may result in speedier recovery than an open procedure. The literature on this approach primarily consists of case reports and studies with smaller cohorts [8][9]11,[16][17][18] . This study aims to report the largest cohort published to date in hemodialysis patients undergoing AVF superficialization via liposuction technique.…”