Liposuction for Superficialization of Deep Veins after Creation of Arteriovenous Fistulas

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.

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“…Although necessary, drains may increase the risk of infection. [ 8 10 ] We use one or two drains along each side of matured outflow vein.…”

Section: Discussionmentioning

confidence: 99%

“…We did not notice any skin necrosis following this procedure although there is a risk of such a complication. [ 10 ] When skin necrosis occurs additional procedures (i.e., necrectomies or skin flaps) are required, delaying AVF cannulation and in rare cases abandonment. [ 10 ]…”

Section: Discussionmentioning

confidence: 99%

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

Sułkowski¹,

Matyja²,

Pasternak³

2018

Indian J Nephrol

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“…Superficialization of an AVF as second stage procedure by means of flap elevation and open lipectomy , have been shown to be effective yet invasive options to prepare the cephalic vein for needling in obese patients. Previous attempts of minimally invasive procedures, such as ultrasound‐guided liposuction , were shown to be associated with wound necrosis and large hematomas.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Superficialization of Arteriovenous Fistula: A Novel Technique With Common Devices

et al. 2018

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“…The reduced longevity of vascular access may be due to compression of the outflow vein by the larger mass of subcutaneous tissue, and as a result of the latter, the access also is more difficult to cannulate as it lies deeper within the subcutaneous tissue. Additional procedures, including lipectomy, superficialization and liposuction have been shown to increase the success for cannulation and overall access survival, 45,46 for example, with one study reporting functional AVF rates of 93% at 1 year and 91% at 2 years in obese patients 47 . Bovine carotid artery xenografts have the same primary and secondary patency rates in obese as compared with non‐obese patients 48 .…”

Section: Complications Of Obesity In the Hd Patientmentioning

confidence: 99%

Impact of obesity on dialysis and transplant and its management

Diwan

Cuffy

Linares‐Cervantes

et al. 2020

Seminars in Dialysis

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The prevalence of obesity in the United States and the world is increasing to unprecedented levels. Obesity is defined as a body mass index (BMI) ≥30 kg/m 2 , severe obesity as a BMI ≥35 kg/m 2 , and extreme obesity as ≥40 kg/m 2 . 1 In 2015-2016, approximately 93.3 million or 39.8% of the USA adult population was obese, and by 2030 this is estimated to increase to more than 50%. 2 Obesity is also increasing in the dialysis and renal transplant population; the proportion of patients undergoing kidney transplantation who are obese (BMI ≥30 kg/m 2 ) is currently 60%. 3 This increased prevalence of obesity has posed new challenges to accessing, delivering, and maintaining optimal care of patients with chronic kidney disease, including those treated with hemodialysis (HD), peritoneal dialysis (PD), and kidney transplant. [3][4][5][6] Obesity is associated with a multitude of complications in the transplant recipient including delayed graft function, acute rejection, wound complications, prolonged hospitalization, new onset diabetes mellitus, cardiovascular complications, [7][8][9] and reduced graft survival. 4-6,10-17 Recognition of these associated complications has led many centers to limit transplant candidacy at a BMI of 35-40 kg/m 2 . Singularly, obesity has become a major obstacle to life-saving kidney transplant and is the third-most common reason for patients to be inactive on the kidney transplant waitlist. 18In this review, we discuss the morbidity associated with obesity and strategies to prevent and manage these complications, as well as medical and surgical treatment of obesity in the end-stage kidney disease (ESKD) population. | THE OB E S IT Y PAR ADOXParadoxically, obesity has been associated with increased survival in the HD population, while a normal or low BMI has been associated with worse outcomes. 19,20 In a meta-analysis of over 190 000 patients, obese patients were 34% less likely to die than those of normal BMI, 21 while the lowest all-cause and cardiovascular mortality was associated with a BMI of 40-45 kg/m 2 . 22 Multiple theories have been proposed to explain the 'obesity paradox'. First and foremost, it remains unclear that this represents a true 'cause and effect' relationship. Rather, this may reflect confounding by comorbid illness and/or inflammation, or survivor bias, that obese patients reaching ESKD are a highly atypical subgroup of the general obese population, most of which has died before reaching ESKD. This may also be a result of competing risks that the dialysis patient does not survive long enough for the increase in cardiovascular and other disease processes that are directly caused by obesity to manifest. 20,[23][24][25][26][27][28][29][30]

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Liposuction for Superficialization of Deep Veins after Creation of Arteriovenous Fistulas

Cited by 24 publications

References 12 publications

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

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

Endoscopic Superficialization of Arteriovenous Fistula: A Novel Technique With Common Devices

Impact of obesity on dialysis and transplant and its management

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