Lipectomy as a new approach to secondary procedure superficialization of direct autogenous forearm radial-cephalic arteriovenous accesses for hemodialysis

Abstract

Lipectomy is a safe, effective, and durable approach to make deep arterialized forearm veins accessible for routine cannulation for hemodialysis in obese patients. It might even be hypothesized that incident obese dialysis patients will eventually have the highest proportion of radial-cephalic fistulas because they often have distal veins that have been preserved by their fat from previous attempts at cannulation for blood sampling or infusion.

Placement of wrist ulnar-basilic autogenous arteriovenous access for hemodialysis in adults and children using microsurgery

“…Second-stage superficialization was performed successfully in two obese patients, including one transposition to the volar aspect of the forearm, with a new anastomosis to the radial artery at 3 months and one lipectomy limited to the upper forearm at 12 months. 16 All fistulas were checked clinically by the surgeon at 2 months in combination with duplex ultrasound examination. Juxta-anastomosis stenoses were treated by surgical reanastomosis.…”

Endoscopic basilic vein transposition for hemodialysis access

“…For these patients, we prefer a lipectomy procedure to transposition, leaving the vein undisturbed. 40 Liposuction may become a more common operation for these individuals in the future. 41 We did not include operative times in our analysis because our techniques and available tools changed significantly during the study period.…”

Venous Window Needle Guide for deep vessels and difficult arteriovenous fistula cannulation

“…When difficult cannulation of the AVF is anticipated or established, various surgical strategies may be considered based on the patient's medical history, vascular state and more often the surgeon's experience and preference. Among these, superficialization/transposition of the arterialized vein or arteriovenous graft (AVG) represent the most common strategies, although surgical lipectomy [7] or liposuction [8] may also, though less frequently, be adopted. A recent review on this issue has been published including the presentation of a new, totally implantable device, i.e., the Venous Window Needle Guide (VWINGTM, Vital Access, Salt Lake City, UT, USA) which is especially designed for deep vessels, and is targetoriented to facilitate cannulation of the AVF by the so-called button-hole (BH) technique [9].…”