Superficialization of deep arteriovenous dialysis access through fat removal in one stage.

What is it about?

Deep cephalic veins especially in obese end stage renal disease pose a problem when used in arteriovenous dialysis fistula as a place for dialysis cannulation. Several procedures had been tried to make them accessible for needle insertion in a process called superficialization. All these procedures are performed in a second stage operation about 2 months after the primary fistula creation that means second operation and 3 months waiting for access use. During this period the patient has to use central venous catheter for dialysis which has many disadvantages. Performing lipectomy in one stage helps to rapidly use the access after half of this period and avoids dissection of the vein unlike other superficialization procedures.

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Why is it important?

Fat removal over the vein of access has multiple advantages. First, no vein dissection avoiding complications like kinking and twisting of the vein observed after vein mobilization in other methods. Second, small incisions are used, one or two incisions according to the length of deep segment. Third, these small incisions are transverse not longitudinal, so more cosmetic results are obtained. Forth, saving time for the patient as one stage operation makes the dialysis access usable after about half the duration of wait observed after 2 stages operation, also the expenses are of only one operation. Fifth, saving the patient from Central venous catheter complications associated with use of multiple catheters for long periods.

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