Superficialization Methods of Arteriovenous Fistula in Obese Patients: A Review of the Literature

Tasopoulou, Kalliopi-Maria; Argyriou, Christos; Kakkos, Stavros K.; Mourvati, Efthimia; Georgakarakos, Efstratios; Thodis, Elias; Lazarides, Miltos K.; Georgiadis, George S.

doi:10.1016/j.avsg.2021.12.013

Cited by 5 publications

(21 citation statements)

References 42 publications

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“…Superficialization of the arterialized vein to facilitate cannulation of the AVF can be achieved with several techniques, such as tunnel transposition, simple elevation of the vein, or lipectomy. 1 , 9 , 11 - 19 , 22 Placement of a subcutaneous needle guide (VWING) was also reported recently by Hill et al 23 …”

Section: Discussionmentioning

confidence: 65%

“… 1 - 4 , 18 , 19 A mature AVF that is functioning well, but cannot be cannulated because of limb obesity, does not provide any benefit and contributes to prolonged catheter dependence and its potential complications, causing frustration for the patient and the health care team. 6 - 12 , 18 , 19 This study observed a mean preoperative cephalic vein depth of 7.9 mm, which was reduced to a mean depth of 4.7 mm at post-intervention follow-up. Complications occurred in nine patients (40.9%), all considered of low morbidity and none of which caused delays in the access being passed as ready for use.…”

Section: Discussionmentioning

confidence: 99%

“…Obese patients often need additional procedures because of vein depth, in order to enable adequate AVF maturation. 2 - 4 , 19 This is compounded by higher failure rates because of thrombosis or dysfunction. 4 , 18 Paradoxically, for the same reasons, many obese patients have cephalic veins considered adequate for a fistula that have been spared repeated injury before dialysis because of their inaccessible location.…”

Section: Discussionmentioning

confidence: 99%

“… 4 , 18 Paradoxically, for the same reasons, many obese patients have cephalic veins considered adequate for a fistula that have been spared repeated injury before dialysis because of their inaccessible location. 4 , 11 , 19 , 20 Ultrasound enables precise, safe, and convenient assessment of whether these veins can be used for creation of autogenous accesses. 19 - 21 …”

Section: Discussionmentioning

confidence: 99%

“… 4 , 11 , 19 , 20 Ultrasound enables precise, safe, and convenient assessment of whether these veins can be used for creation of autogenous accesses. 19 - 21 …”

Section: Discussionmentioning

confidence: 99%

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Lipectomy as an alternative for superficialization of autologous AVF in obese patients: experience of a referral center in Amazon

Reis,

Ribeiro,

Melo

et al. 2024

J. vasc. bras.

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Background The preferred vascular access for hemodialysis is a native arteriovenous fistula (AVF) because it offers the best results in the short and long terms, lower morbidity and mortality, and has additional advantages in relation to central venous catheters or arteriovenous grafts. However, obesity can present an additional challenge because of the barrier of subcutaneous cellular tissue covering the surface of the vein to be punctured. Objectives The authors review their experience with excision of subcutaneous tissue (lipectomy) overlying upper arm cephalic vein arteriovenous fistulas in obese patients. Methods Consecutive vascular access patients undergoing lipectomy for cannulation with difficult access because of vein depth were reviewed. Cephalic vein depth was measured by ultrasound in all cases. Results Twenty-two patients were reviewed (15 men and 7 women), with a mean body mass index of 34.0 kg/m2 (range: 28-40 kg/m2). Mean age was 58.4 years. The mean preoperative vein depth of 7.9 mm (range: 7.0-10.0 mm) was reduced to 4.7 mm (range: 3.0-6.0 mm) (P 0.01). The mean follow-up period for patients was 13.2 months. Four patients were lost to follow-up and four died during the period due to causes unrelated to vascular access. Conclusions Obesity should not be a limiting factor to creation of a native AVF, since lipectomy is a relatively simple option for superficialization, enabling functioning native and deep arteriovenous fistulas in obese patients.

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“… 4 , 11 , 19 , 20 Ultrasound enables precise, safe, and convenient assessment of whether these veins can be used for creation of autogenous accesses. 19 - 21 …”

Section: Discussionmentioning

confidence: 99%

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