One-stage operation for superficialization of native radio-cephalic fistula in obese patients

Okawa, T.; Murakami, Masaaki; Yamada, Ryo; Tanaka, Satoshi; Mori, Kiyoshi; Mori, Noriko

doi:10.1177/1129729818762994

Cited by 5 publications

(2 citation statements)

References 18 publications

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“…The endoscopic approach was developed according to patient preference for minimal invasiveness and with the need to have visual control of the operating field. In contrast to the recently presented one stage superficialisation, 16 all the matured AVF procedures were secondary.…”

Section: Discussionmentioning

confidence: 67%

Endoscopic Superficialisation of Haemodialysis Arteriovenous Fistulas in Obese Patients – Safety, Feasibility, and Outcomes

Zeindler

Richarz

Franchin

et al. 2019

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS Second stage endoscopic superficialisation of haemodialysis arteriovenous fistulae expands surgical options in obese patients as it is a safe and effective minimally invasive procedure to reduce cephalic vein depth.Objective: The aim was to evaluate the safety and feasibility of endoscopic superficialisation (ES) in patients with deeply located cephalic veins in well matured arteriovenous fistulae (AVF) and to present functional outcomes. Methods: All patients with cannulation difficulties due to a deep lying cephalic vein of more than 6 mm but with an otherwise matured AVF with a straight needle access segment of at least 6 cm were included in this retrospective study. Procedure related safety, defined as completion of ES with no need for conversion to open surgery, and feasibility in terms of cephalic vein depth reduction were assessed. The primary endpoint was three successfully performed haemodialysis sessions using the endoscopically superficialised AVF during a minimum follow up of 12 months. Results: From June 2013 to August 2017, 12 patients with a mean body mass index of 33.5 AE 3.9 kg/m 2 underwent ES as a second stage procedure following radiocephalic (n ¼ 5) or brachiocephalic AVF (n ¼ 7) creation. All procedures were conducted endoscopically. Ultrasound imaging 12 weeks post-operatively documented a reduction in the depth of the cephalic vein from a mean of 10.1 AE 1.4 mm to 4.3 AE 0.8 mm. The mean duration of the ES was 69 AE 26.0 min with 67% performed under locoregional anaesthesia. In all but one patient with a cephalic vein of poor wall quality leading to recurrent haematoma, haemodialysis was performed successfully following ES. Conclusions: Endoscopic superficialisation of the cephalic vein is a safe and effective technique. Providing good functional results, ES represents an alternative approach for second stage superficialisation in obese patients.

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Section: Discussionmentioning

confidence: 67%

Endoscopic Superficialisation of Haemodialysis Arteriovenous Fistulas in Obese Patients – Safety, Feasibility, and Outcomes

Zeindler

Richarz

Franchin

et al. 2019

European Journal of Vascular and Endovascular Surgery

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

Tasopoulou¹,

Argyriou²,

Kakkos³

et al. 2022

Annals of Vascular Surgery

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One-stage operation for superficialization of native radio-cephalic fistula in obese patients

Abstract: This small series of patients indicates that one-stage superficialization of radio-cephalic fistula is a safe and effective option to start hemodialysis in obese subjects.

Cited by 5 publications

References 18 publications

Endoscopic Superficialisation of Haemodialysis Arteriovenous Fistulas in Obese Patients – Safety, Feasibility, and Outcomes

Endoscopic Superficialisation of Haemodialysis Arteriovenous Fistulas in Obese Patients – Safety, Feasibility, and Outcomes

Impact of obesity on dialysis and transplant and its management

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

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