One-stage lipectomy superficialization of deep cephalic veins in comparison with secondary lipectomy in arteriovenous dialysis fistula

Abstract

Objective:

Lipectomy is an acceptable method of cephalic vein superficialization in hemodialysis arteriovenous fistula. However, limiting it to be a secondary procedure may prolong time between fistula creation and successful cannulation posing more risk of central venous catheter use.

Aim:

The aim of this study is to evaluate primary surgical lipectomy performed at the time of arteriovenous fistula creation in comparison with secondary lipectomy.

Patients and methods:

Between June 2015 and January 2017, 59 adult end-stage renal disease patients were allocated non-randomly to group I, 35 patients had arteriovenous fistula with primary lipectomy of forearm or arm deep cephalic veins, and group II, 24 patients who had secondary lipectomy of deep forearm or arm cephalic veins after primary arteriovenous fistula.

Results:

Mean body mass index was 28.2 ± 3.2 kg/m² versus 29.4 ± 2.5 kg/m² in group I versus II, respectively. Mean time from fistula creation to cannulation was 6 ± 0.5 weeks in group I versus 14.5 ± 5.5 weeks in group II (p < 0.0001*). Immediate technical success was achieved in all cases in both groups. Clinical success was 94.29% (33/35) versus 91.67% (22/24) in group I versus II, respectively. Cumulative 1-year primary patency rate was 88% in primary and 86.47% in secondary lipectomy; p = 0.842.

Conclusion:

Lipectomy is a minimally invasive procedure carried out through small incision(s). Primary and secondary lipectomy procedures have few complications, and acceptable technical and clinical success rates. Primary lipectomy has the advantage to hasten fistula use and diminish central venous catheter dependency.

Keywords

Lipectomy arteriovenous fistula superficialization

Get full access to this article

View all access options for this article.

References

Tordoir

van Loon

Peppelenbosch

et al . Surgical techniques to improve cannulation of hemodialysis vascular access. Eur J Vasc Endovasc Surg 2010; 39: 333–339.

Jennings

Galt

Shenoy

et al . The Venous Window Needle Guide, a hemodialysis cannulation device for salvage of uncannulatable arteriovenous fistulas. J Vasc Surg 2014; 60(4): 1024–1032.

McCann

Moore

ZE.

Interventions for preventing infectious complications in haemodialysis patients with central venous catheters. Cochrane Database Syst Rev 2010; 20(1): CD006894.

Van Loon

Kessel

van der Sande

et al . Cannulation practice patterns in haemodialysis vascular access: predictors for unsuccessful cannulation. J Ren Care 2009; 35(2): 82–89.

Dougherty

Hayes

Jr Calligaro

KD.

Arteriovenous access for hemodialysis. In: Chaikof

Cambria

(eds) Atlas of vascular surgery and endovascular therapy: anatomy and technique. 1st ed. Philadelphia, PA: Elsevier, 2014, pp. 730–738.

Silva

Jr Hobson

2nd Pappas

et al . A strategy for increasing use of autogenous hemodialysis access procedures: impact of preoperative noninvasive evaluation. J Vasc Surg 1998; 27: 302–307.

Schmidli

Widmer

Basile

et al . Vascular access: 2018 clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2018; 55: 757–818.

Bourquelot

Tawakol

Gaudric

et al . Lipectomy as a new approach to secondary procedure superficialization of direct autogenous forearm radial-cephalic arteriovenous accesses for hemodialysis. J Vasc Surg 2009; 50: 369–374.

Barnard

Taubman

Jennings

WC.

Accessible autogenous vascular access for hemodialysis in obese individuals using lipectomy. Am J Surg 2010; 200: 798–802.

10.

Evans

Meecham

Buxton

et al . Vascular access in the obese: superficialisation of native radio-cephalic and brachio-cephalic fistulae. J Vasc Access 2015; 16(2): 126–129.

11.

Bourquelot

Karam

Robert-Ebadi

et al . Transposition, elevation, lipectomy and V-Wing for easy needling. J Vasc Access 2015; 16: S108–S113.

12.

Wong

Ward

Taylor

et al . Factors associated with early failure of arteriovenous fistulae for haemodialysis access. Eur J Vasc Endovasc Surg 1996; 12: 207–213.

13.

Corpataux

Haesler

Silacci

et al . Low-pressure environment and remodelling of the forearm vein in Brescia-Cimino haemodialysis access. Nephrol Dial Transplant 2002; 17: 1057–1062.

14.

Caroli

Manini

Antiga

et al . Validation of a patient-specific hemodynamic computational model for surgical planning of vascular access in hemodialysis patients. Kidney Int 2013; 84: 1237–1245.