title: Accessible autogenous vascular access for hemodialysis in obese individuals using lipectomy.
abstract: BACKGROUND
  Arteriovenous fistula are created less frequently in obese individuals, and fewer of these access procedures become functional. The authors review their experience with the excision of subcutaneous tissue (lipectomy) overlying upper arm cephalic vein arteriovenous fistulas in obese patients.
  
  
  METHODS
  Consecutive vascular access patients undergoing lipectomies for difficult access cannulation due to vein depth were reviewed. Cephalic vein depth was measured by ultrasound at 3 sites before lipectomy and again before the first cannulation.
  
  
  RESULTS
  Thirty patients were reviewed, with a mean body mass index of 40.2 kg/m² (range, 28-57.7 kg/m²). The mean age was 52 years. Seventeen patients were women, and 19 had diabetes. The mean preoperative vein depth of 15.8 mm (range, 6-30 mm) was reduced to 4.1 mm (range, 3-8 mm) (P ≤ .01). All fistulas were functional, and only 1 failed during a follow-up period of 2.2 to 53.2 months.
  
  
  CONCLUSIONS
  Lipectomy offers a relatively simple and successful method of extending direct autogenous vascular access to obese individuals.
authors.affiliation: Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK, USA.
authors.forename: Kayla J
authors.initials: KJ
authors.lastname: Barnard
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Taubman
authors.forename: William C
authors.initials: WC
authors.lastname: Jennings
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001132:Arm / Q000098:blood supply / Q000601:surgery*; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D015992:Body Mass Index; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D015187:Lipectomy; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000601:surgery*; D006435:Renal Dialysis; D014654:Vascular Patency