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

Abstract

Superficialisation of brachio/radio-cephalic fistulae is an excellent option to optimise the cephalic vein for needling, assisting primary patency. Superficialisation of the cephalic vein helps maintain long-term functional access in overweight and obese patients.

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

“…The increasing incidence of obesity poses a challenge to treat ESRD patients with dialysis. [ 4 6 ] Among obese ESRD patients, a matured but deeply located outflow veins are often observed leading to difficult cannulation despite adequate flow and venous diameter. Various types of surgical procedures are needed to facilitate easy cannulation of otherwise inaccessible dialysis vascular access.…”

“…[ 4 ] Obesity itself does not preclude AVF creation, but achieving recommended <6 mm of depth for outflow vein is often difficult. [ 4 5 6 ] In obese ESRD patients, a matured outflow vein with the adequate flow is often located deeper than 6 mm and is difficult to cannulate. A surgical superficialization of a matured outflow vein is often needed for easy cannulation for dialysis.…”

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

“…Superficialization is becoming an increasingly successful method used for obese cases. [7][8][9] In almost all reports, twostage operation is performed for this purpose. [7][8][9] However, there are few reports of one-stage technique.…”

“…[7][8][9] In almost all reports, twostage operation is performed for this purpose. [7][8][9] However, there are few reports of one-stage technique. In the case of two-stage superficialization procedure, because of multiple operations, the period required for stable puncture is much longer than the one-stage procedure.…”

“…Recently, there are several reports describing two-stage superficialization of AVF in the case of deeply buried vessels. [7][8][9] In this study, we investigated the utility and complications of one-stage superficialization of native radio-cephalic fistula in the obese patients treated at our hospital.…”