Journal of Vascular Surgery Cases and Innovative Techniques (Dec 2022)
Liposuction to improve vascular access in hemodialysis patients with arteriovenous fistulas
Abstract
Background: Arteriovenous fistulas (AVFs) are indispensable in the care of patients with end-stage renal disease requiring hemodialysis. Obesity is a common comorbidity in hemodialysis patients, often making AVF cannulation technically challenging. Liposuction can be performed for superficialization of the AVF without the need for an open superficialization procedure. The aim of the present study was to evaluate the outcomes of liposuction to improve AVF access for hemodialysis. Methods: We performed a retrospective medical record review of patients who had undergone liposuction over an AVF at our institution from January 2000 to September 2021. Data were collected on the demographics, medical comorbidities, AVF site and depth, AVF diameter and flow, operative details, surgical complications, and follow-up. Results: A total of 19 patients had been referred by the hemodialysis clinic for liposuction. Their mean age was 55.5 years, and their mean body mass index was 39.5 kg/m2. Either liposuction alone or liposuction combined with minimal access direct lipectomy was performed to superficialize the AVF. All procedures were performed secondarily, after prior creation of the AVF. Of the 19 patients, 18 had had an upper AVF and 1 had had a lower extremity AVF graft. Of the 19 patients, 12 (63%) had proceeded to hemodialysis after one liposuction. The mean time to cannulation for 10 of these 12 patients was 52.1 ± 25.6 days. Two of the 12 patients were excluded from the mean calculation to prevent skewing from their prolonged time to requiring dialysis initiation. Of the 19 patients, 2 had required additional liposuction sessions, and 1 had required AVF intervention after the first liposuction attempt before achieving successful cannulation. Four patients (21%) had had unsuccessful cannulation despite additional liposuction or AVF interventions owing to AVF stenosis or thrombosis. Overall, 15 of the 19 patients (79%) had successfully proceeded to dialysis in the same extremity. The mean access depth had decreased from 1.75 cm before liposuction to 0.93 cm after liposuction. The mean volume of fat removed was 92.3 cm3. Of the 16 patients with prior dialysis catheters, 11 were eventually removed after surgery once the vascular site was accessible. The body mass index correlated positively with the interval to the first successful cannulation (r = 0.5881; P < .05). The surgical complications included two cases of cellulitis treated with oral antibiotics. The mean follow-up time was 38.3 months. Conclusions: Our results have shown that liposuction can be performed safely in obese patients requiring hemodialysis and was successful in improved AVF access for 15 of the 19 patients (79%) in our cohort. Larger studies are needed to compare the outcomes of this technique with those of open superficialization.
