Salvage of Inaccessible Arteriovenous Fistulas in Obese Patients: A Review of 132 Brachiocephalic Fistulas

Abstract

The two main factors leading to a functional fistula are maturity and accessibility. The aim of this review was to describe a technique of superficialization for inaccessible brachiocephalic fistulas, and to identify the patients that benefit from superficialization. One hundred and thirty-two brachiocephalic arteriovenous fistulas developed from November 2003 to December 2006 were reviewed for primary maturation. In the mature group, patients were evaluated for fistula accessibility. Inaccessible fistulas were selected for superficialization via our technique of vein mobilization using small skip incisions. Analysis of superficialized and nonsuperficialized groups included age, demographics, and comorbidities. Ninety-nine patients were in the mature group, and 33 in the immature group; primary nonmaturation was 25 per cent. Analysis within the mature group was between nonsuperficialized (n = 81) and superficialized (n = 18) patients. The superficialized group had less hypertension (83% vs 98%, P < 0.05), significantly higher BMI (31 vs 27, P < 0.05), and was mostly female (78% vs 49%, P < 0.05). All superficialized fistulas accommodated successful hemodialysis postoperatively. To conclude, patients with mature but inaccessible fistulas were salvaged by superficialization. This population had significantly higher BMI, less hypertension, and female prevalence. Identifying these patients is important because salvage of their fistula can prevent premature progression to alternate autogenous arteriovenous access procedures.

The Basilic Vein and the Cephalic Vein Perform Equally in Upper Arm Arteriovenous Fistulae

“…The majority of these patients were female. 28 We did not observe a difference in BMI between males or females. However, the body fat in men is differently distributed compared to women and it may be that more pronounced subcutaneous fat in the arms of women influenced the selection of the AV fistula.…”

Vascular access in the Obese: Superficialisation of Native Radio-Cephalic and Brachio-Cephalic Fistulae

“…The population group was predominantly female (78%) and had an elevated BMI (BMI 31 kg/m 2 ). All superficialised fistulae supported haemodialysis post operatively (9). Weyde et al performed 71 radio-cephalic superficialisation procedures on a patient population with a mean BMI of 34.6 kg/m 2 .…”

Survival and Complications of Arteriovenous Fistula Dialysis Access in an Elderly Population

“…We wish to point out, however, that while the three groups of patients were similar in as far as diabetes mellitus and cardiac conditions are concerned, the group of patients for which proximal AVF were created included seven obese patients (22%) with a body mass index (BMI) >30, whereas obesity was virtually absent in the other two groups of patients. It appears important to underline this aspect in light of recent studies that have identified obesity as a condition capable of influencing AVF survival (11) because of the likelihood of soft-tissue compression of the venous outflow (12) and have observed that the superficialization of the vein is a means of salvaging the access in such circumstances (13).…”