Background
The creation of an arteriovenous fistula in obese patients with end-stage-renal-disease,
might not lead to a successful hemodialysis session, partly due to excess adipose
tissue overlapping the enlarged vein. This review summarizes the available evidence
on superficialization methods in studies dealing with obese patients.
Methods
An English-language literature search was undertaken in the MEDLINE/SCOPUS databases
looking for publications that described procedures of salvaging autologous arteriovenous
access in upper extremities of obese patients. Perioperative outcomes including technical
and clinical success, mean vein depth reduction, wound complications and patency rates
were compared within all identified techniques.
Results
We identified 12 prospective and 8 retrospective studies. A total of 1149 patients
with a mean age 57.2 (range: 49–68) years and a mean BMI 35.8 (range: 28.2–40.8) kg/m2 underwent mainly radial-cephalic and brachial-cephalic arteriovenous fistula superficialization
procedures [transposition, 54%; elevation, 11.1%; lipectomy, 26.1%; liposuction, 2.4%;
implantation of a venous window needle guide device, 6.4%]. Technical success was
similar between all methods (≥96%). However, successful cannulation was lower after
liposuction and elevation (81.5% and 78.1% respectively). Transposition achieved lower
mean vein depth reduction and clinical success when compared with lipectomy (4.9 mm
vs. 8.8 mm and 90% vs. 92.7% respectively). Transposition and liposuction had the
lowest and highest complication rate respectively (1.6% vs. 40.8%). Primary and secondary
patency rates were lower with liposuction (51.8% and 76.6% respectively), while lipectomy
and elevation achieved the highest primary patency rates (68.3% and 71.6% respectively)
at 12 months.
Conclusions
In obese patients, all superficialisation techniques report high technical success
rates. Although limited by the design of individual published studies and lack of
a standard for reporting outcomes, these results lead to satisfactory postoperative
and early outcomes. In aggregate, lipectomy and transposition are more clinically
effective and more durable procedures.
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Article Info
Publication History
Published online: December 23, 2021
Accepted:
December 6,
2021
Received in revised form:
December 5,
2021
Received:
August 16,
2021
Footnotes
Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Identification
Copyright
© 2021 Published by Elsevier Inc.
