Superficialization of arteriovenous fistulae employing minimally invasive liposuction

Abstract

Superficialization of arteriovenous fistulae allows for improved dialysis access allowing for prolonged utilization and more efficient dialysis treatment. Multiple methods are described for superficializing arteriovenous fistulae, and minimizing the surgical intervention is advantageous for patient recovery and potentially improved outcomes. We describe a novel technique of superficialization of an upper extremity arteriovenous fistula employing ultrasound-guided liposuction. This article describes the suction lipectomy technique and the tools necessary for superficialization of an upper extremity arteriovenous fistula.

Editor's Choice – Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS)

“…244e247 Liposuction over a guard has also been used successfully to elevate the vein draining an AVF to facilitate needling. 248,249 An implantable titanium venous window needle guide may be another alternative to aid cannulation in obese patients and has been reported to be useful and durable with low infection rates in a non-randomised study. 250…”

New Insights into Dialysis Vascular Access: What Is the Optimal Vascular Access Type and Timing of Access Creation in CKD and Dialysis Patients?

“…Many techniques have been described to decrease the distance between a vein and the skin. The most common technique is surgical elevation of the AVF (42), but other techniques include open lipectomy and liposuction (43,44).…”

Strategies to Assist Fistula Maturation and Successful Use for Hemodialysis

“…(4) Ultrasound-guided liposuction -under ultrasound image guidance and tumescent solution infusion to subcutaneous tissue, the subcutaneous tissue above the fistula is removed using liposuction technique. 7 The potential complications of superficialization include hematoma or seroma formation, injury to fistula and wound problems. As most of the patients requiring superficialization are morbidly obese, risk of general anesthesia is usually substantial.…”