title: Liposuction for superficialization of deep veins after creation of arteriovenous fistulas.
abstract: OBJECTIVE
  Many individuals with end-stage renal disease (ESRD) have adequate arteries and veins for construction of an arteriovenous fistula (AVF) but the fistula may be too deep to cannulate because of overlying adipose tissue. This study evaluated the safety and efficacy of liposuction to superficialize deep AVFs.
  
  
  METHODS
  Between September 2009 and January 2011, 13 patients participated in the study. Mean body mass index (BMI) was 39.1 kg/m2. The study was limited to brachiocephalic and radiocephalic fistulas. Mean fistula depth was 8.1 mm. The primary endpoint was the date of the first successful cannulation with two 17-gauge needles. Patients were followed for 12 mo.
  
  
  RESULTS
  Eleven subjects (85%) underwent successful two-needle cannulation a mean of 33.7 days after the procedure. One patient died of endocarditis and one developed a hematoma and wound necrosis that required surgical elevation to enable cannulation. Projection and palpability of the fistulas tended to increase over time. Mean tissue removed was 243 mL and correlated positively with the number of days to cannulation (r=0.74, p=0.01). Greater BMI correlated positively with more surgical site complications and delays in cannulation. At 12 mo, primary patency after liposuction was 50% and secondary patency was 83%.
  
  
  CONCLUSIONS
  Most subjects had prompt, uncomplicated cannulation but a few had wound necrosis, large hematomas and prolonged time until cannulation. Liposuction is effective in enabling cannulation of deep vein fistulas but because of the substantial risk of serious surgical site complications, it may not be the ideal method.
authors.affiliation: 1 Ladenheim Dialysis Access Centers, Fresno, CA - USA.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Ladenheim
authors.forename: Juergen P
authors.initials: JP
authors.lastname: Krauthammer
authors.forename: John
authors.initials: J
authors.lastname: Burnett
authors.forename: Theresa
authors.initials: T
authors.lastname: Dunaway
authors.forename: Sanah
authors.initials: S
authors.lastname: Parvez
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D015992:Body Mass Index; D002140:California; D002404:Catheterization; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D015187:Lipectomy / Q000009:adverse effects; D011446:Prospective Studies; D006435:Renal Dialysis; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*; D014654:Vascular Patency