Liposuction for Superficialization of Deep Hemodialysis Vascular Access: A Novel Application

Background: More than 65% of patients with end-stage renal disease (ESRD) use arteriovenous fistulas (AVFs) for hemodialysis. The increasing incidence of comorbid ESRD and obesity (body mass index, >35 kg/m 2 ) precludes patients from kidney transplantation, resulting in a need for long-term, durable AVF access. Compared with traditional superficialization techniques for overlying adiposity, liposuction is minimally invasive and well-tolerated, allowing for earlier fistula use with lower complications. We present the detailed surgical technique for superficialization of AVFs using liposuction. Methods: Fourteen patients with well-matured but difficult-access fistulas due to adiposity were selected. Preoperative ultrasound mapped depth of fistulas. Tumescent liposuction was completed in a cross-hatched manner. Intraoperative ultrasound confirmed cannula positioning and measured fistula depth. A palpable thrill remained throughout superficialization. Cannulation began 4 weeks postoperatively. Results: Mean access depth preoperatively was 10.8 mm (8–15 mm), immediately postoperative was 7 mm (6–9 mm), and at 4 weeks was 5.3 mm (4–8 mm). The average usable access length was 12.7 cm (10–15 cm) after surgery. Thirteen fistulas were successfully accessed after liposuction superficialization. All patients were discharged home the same day. There were no postoperative infections or hemorrhage. Conclusions: Early experience with liposuction for superficialization of deep hemodialysis access is promising. This innovative solution has the possibility to improve outcomes and quality of life for patients living with ESRD and obesity. Our experience shows that this is a safe and effective technique to increase patient eligibility, enable successful and early cannulation, and decrease recovery time.