Accessible autogenous vascular access for hemodialysis in obese individuals using lipectomy

BackgroundArteriovenous 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.MethodsConsecutive 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.ResultsThirty 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.ConclusionsLipectomy offers a relatively simple and successful method of extending direct autogenous vascular access to obese individuals.