Lipectomy technique as a second-stage procedure for primarily matured, deep outflow vein in obese individuals

Abstract

Prevalence of obesity is growing in the general population as well as among end-stage renal disease (ESRD) patients requiring dialysis. Obesity often leads to a situation when a mature outflow vein is located deeper than 6 mm and is difficult to cannulate. These obese patients usually require additional procedures to able to successfully cannulate the fistula. The available surgical options include: outflow vein elevation, liposuction, and lipectomy. We present a case of a 57-year-old obese female with ESRD and matured, deeply running, inadequate for cannulation arteriovenous fistula. We present a technique of lipectomy with wide resection of adipose tissue from superior and lateral surfaces of outflow vein. Postoperatively, the skin without the underlying adipose tissue collapses allowing easy cannulation of the long segment of outflow vein with two needles. Lipectomy of mature but deeply located outflow vein is a second-stage elective procedure. Wide resection of adipose tissue helps create easy to access cannulation zone in obese individuals.

WHOQOL-BREF survey of quality of life among dialyzed end-stage renal disease patients

“…Additionally, HD may cause QOL impairments [1,2,16,17]. The ESRD patients, regardless of the treatment modality, have to manage many adversities: cognitive impairment, physical symptoms, fluid and dietary restriction, and changed body image [3,5,6,15,18,19]. They may have many risk factors of reduced QOL such as diabetes, hypertension, dyslipidemia, hypoxemia, proinflammatory state, as well as fluid, osmolar and uremic toxin variations [6].…”

One-stage basilic vein tunneled transposition for hemodialysis access

“…Leszek Sułkowski 1 , Czesław Osuch 2 , Maciej Matyja 2 , Andrzej Matyja 2 The autogenous arteriovenous fistula (AVF) is an access of choice for chronically hemodialyzed patients [1][2][3][4], preferred over central venous catheter placement [5]. The AVF's access vein on the upper extremity can be either the cephalic or basilic vein (BV).…”

“…When the favorably located cephalic vein is narrow or thrombosed, the BV remains an alternative [6]. The deep location of BV in the arm makes this vein unsuitable for puncture without superficialization [1,2,7]. There are several techniques enabling the use of the deeply located BV, including lipectomy, BV elevation and BV tunnel transposition (BVTT) [1,2,7,8].…”

“…The deep location of BV in the arm makes this vein unsuitable for puncture without superficialization [1,2,7]. There are several techniques enabling the use of the deeply located BV, including lipectomy, BV elevation and BV tunnel transposition (BVTT) [1,2,7,8]. Therefore, BV AVF remains an access option for difficult cases, along with central venous catheter placement or prosthetic graft AVF [2].…”

“…The cephalic vein compared with the BV is more favorable, superficially located on the anterior surface of the arm and is more frequently used for AVF creation. However, BV AVFs remain an important option for ESRD patients, when the cephalic vein is inadequate for AVF creation, narrow or thrombosed [1,8,10]. BV AVFs allow these patients to avoid catheter placement and prosthetic graft AVFs along with complications associated with implantation of catheters or PTFE grafts.…”