title: Vascular access in the obese: superficialisation of native radio-cephalic and brachio-cephalic fistulae.
abstract: OBJECTIVE
  The Department of Health estimates that currently in the UK, 61.3% of the population are overweight or obese (BMI >25 kg/m2). Fistulae in the obese often fail to mature or prove inadequate to needle due to excessive depth (>6 mm). This study is a summary of our experience with brachio and radio-cephalic vein superficialisation in the obese.
  
  
  METHODS
  From May 2008 to October 2012, 22 patients underwent superficialisation of the cephalic vein following radio-cephalic or brachio-cephalic Arterio-venous fistula (AVF) creation. Data were obtained from a prospective database (Cyberen®) and retrospectively analysed.
  
  
  RESULTS
  The study included 23 AVFs in 22 patients (seven males, 15 females), of which 13 were brachio-cephalic and 10 radio-cephalic. The mean age of the patients was 56 years (median 60, range 19-78 years). The mean BMI was 36.7 kg/m2 (median 32, 25-58 kg/m2). Six-week post procedure duplex ultrasonography recorded the mean fistula depth to be 7.7 mm (median 8 mm, 5-15 mm) and mean flow rates were 961 ml/min (median 800 ml/min, 320-1968 ml/min).Of the 23, 21 fistulae matured successfully. There were no procedure-related complications. During follow-up, two patients underwent transplantation prior to fistula use and three patients died of unrelated causes. The remaining 16 fistulae remain in use and under access surveillance.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 1 Department of Vascular Surgery, University Hospital of North Staffordshire, Staffordshire - UK.
authors.forename: Richard P T
authors.initials: RP
authors.lastname: Evans
authors.forename: Lewis
authors.initials: L
authors.lastname: Meecham
authors.forename: Pauline
authors.initials: P
authors.lastname: Buxton
authors.forename: Sadaf
authors.initials: S
authors.lastname: Jafferbhoy
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Legge
authors.forename: Laszlo
authors.initials: L
authors.lastname: Papp
authors.forename: Omer
authors.initials: O
authors.lastname: Ehsan
authors.forename: Arun D
authors.initials: AD
authors.lastname: Pherwani
mesh_terms: D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D001916:Brachial Artery / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000601:surgery*; D011446:Prospective Studies; D017534:Radial Artery / Q000601:surgery*; D012039:Regional Blood Flow; D012189:Retrospective Studies; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency; D014680:Veins / Q000601:surgery*; D055815:Young Adult