José Maciel Caldas Dos Reis, Flávio Roberto Cavalleiro de Macêdo Ribeiro, Glauco Dos Santos Melo, Humberto Balbi Reale, Mariseth Carvalho de Andrade
{"title":"脂肪切除术作为肥胖患者自体动静脉瘘浅表化的替代方法：亚马逊一家转诊中心的经验。","authors":"José Maciel Caldas Dos Reis, Flávio Roberto Cavalleiro de Macêdo Ribeiro, Glauco Dos Santos Melo, Humberto Balbi Reale, Mariseth Carvalho de Andrade","doi":"10.1590/1677-5449.202300542","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The preferred vascular access for hemodialysis is a native arteriovenous fistula (AVF) because it offers the best results in the short and long terms, lower morbidity and mortality, and has additional advantages in relation to central venous catheters or arteriovenous grafts. However, obesity can present an additional challenge because of the barrier of subcutaneous cellular tissue covering the surface of the vein to be punctured.</p><p><strong>Objectives: </strong>The authors review their experience with excision of subcutaneous tissue (lipectomy) overlying upper arm cephalic vein arteriovenous fistulas in obese patients.</p><p><strong>Methods: </strong>Consecutive vascular access patients undergoing lipectomy for cannulation with difficult access because of vein depth were reviewed. Cephalic vein depth was measured by ultrasound in all cases.</p><p><strong>Results: </strong>Twenty-two patients were reviewed (15 men and 7 women), with a mean body mass index of 34.0 kg/m<sup>2</sup> (range: 28-40 kg/m<sup>2</sup>). Mean age was 58.4 years. The mean preoperative vein depth of 7.9 mm (range: 7.0-10.0 mm) was reduced to 4.7 mm (range: 3.0-6.0 mm) (<i>P</i> 0.01). The mean follow-up period for patients was 13.2 months. Four patients were lost to follow-up and four died during the period due to causes unrelated to vascular access.</p><p><strong>Conclusions: </strong>Obesity should not be a limiting factor to creation of a native AVF, since lipectomy is a relatively simple option for superficialization, enabling functioning native and deep arteriovenous fistulas in obese patients.</p>","PeriodicalId":14814,"journal":{"name":"Jornal Vascular Brasileiro","volume":"23 ","pages":"e20230054"},"PeriodicalIF":0.8000,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10984606/pdf/","citationCount":"0","resultStr":"{\"title\":\"Lipectomy as an alternative for superficialization of autologous AVF in obese patients: experience of a referral center in Amazon.\",\"authors\":\"José Maciel Caldas Dos Reis, Flávio Roberto Cavalleiro de Macêdo Ribeiro, Glauco Dos Santos Melo, Humberto Balbi Reale, Mariseth Carvalho de Andrade\",\"doi\":\"10.1590/1677-5449.202300542\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The preferred vascular access for hemodialysis is a native arteriovenous fistula (AVF) because it offers the best results in the short and long terms, lower morbidity and mortality, and has additional advantages in relation to central venous catheters or arteriovenous grafts. However, obesity can present an additional challenge because of the barrier of subcutaneous cellular tissue covering the surface of the vein to be punctured.</p><p><strong>Objectives: </strong>The authors review their experience with excision of subcutaneous tissue (lipectomy) overlying upper arm cephalic vein arteriovenous fistulas in obese patients.</p><p><strong>Methods: </strong>Consecutive vascular access patients undergoing lipectomy for cannulation with difficult access because of vein depth were reviewed. Cephalic vein depth was measured by ultrasound in all cases.</p><p><strong>Results: </strong>Twenty-two patients were reviewed (15 men and 7 women), with a mean body mass index of 34.0 kg/m<sup>2</sup> (range: 28-40 kg/m<sup>2</sup>). Mean age was 58.4 years. The mean preoperative vein depth of 7.9 mm (range: 7.0-10.0 mm) was reduced to 4.7 mm (range: 3.0-6.0 mm) (<i>P</i> 0.01). The mean follow-up period for patients was 13.2 months. Four patients were lost to follow-up and four died during the period due to causes unrelated to vascular access.</p><p><strong>Conclusions: </strong>Obesity should not be a limiting factor to creation of a native AVF, since lipectomy is a relatively simple option for superficialization, enabling functioning native and deep arteriovenous fistulas in obese patients.</p>\",\"PeriodicalId\":14814,\"journal\":{\"name\":\"Jornal Vascular Brasileiro\",\"volume\":\"23 \",\"pages\":\"e20230054\"},\"PeriodicalIF\":0.8000,\"publicationDate\":\"2024-03-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10984606/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Jornal Vascular Brasileiro\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1590/1677-5449.202300542\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q4\",\"JCRName\":\"PERIPHERAL VASCULAR DISEASE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Jornal Vascular Brasileiro","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1590/1677-5449.202300542","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"Q4","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
Lipectomy as an alternative for superficialization of autologous AVF in obese patients: experience of a referral center in Amazon.
Background: The preferred vascular access for hemodialysis is a native arteriovenous fistula (AVF) because it offers the best results in the short and long terms, lower morbidity and mortality, and has additional advantages in relation to central venous catheters or arteriovenous grafts. However, obesity can present an additional challenge because of the barrier of subcutaneous cellular tissue covering the surface of the vein to be punctured.
Objectives: The authors review their experience with excision of subcutaneous tissue (lipectomy) overlying upper arm cephalic vein arteriovenous fistulas in obese patients.
Methods: Consecutive vascular access patients undergoing lipectomy for cannulation with difficult access because of vein depth were reviewed. Cephalic vein depth was measured by ultrasound in all cases.
Results: Twenty-two patients were reviewed (15 men and 7 women), with a mean body mass index of 34.0 kg/m2 (range: 28-40 kg/m2). Mean age was 58.4 years. The mean preoperative vein depth of 7.9 mm (range: 7.0-10.0 mm) was reduced to 4.7 mm (range: 3.0-6.0 mm) (P 0.01). The mean follow-up period for patients was 13.2 months. Four patients were lost to follow-up and four died during the period due to causes unrelated to vascular access.
Conclusions: Obesity should not be a limiting factor to creation of a native AVF, since lipectomy is a relatively simple option for superficialization, enabling functioning native and deep arteriovenous fistulas in obese patients.
期刊介绍：
The Jornal Vascular Brasileiro is editated and published quaterly to select and disseminate high-quality scientific contents concerning original research, novel surgical and diagnostic techniques, and clinical observations in the field of vascular surgery, angiology, and endovascular surgery. Its abbreviated title is J. Vasc. Bras., which should be used in bibliographies, footnotes and bibliographical references and strips.
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