Lipectomy as a new approach to secondary procedure superficialization of direct autogenous forearm radial-cephalic arteriovenous accesses for hemodialysis

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Presentation transcript:

Lipectomy as a new approach to secondary procedure superficialization of direct autogenous forearm radial-cephalic arteriovenous accesses for hemodialysis Pierre Bourquelot, MD, Jan Bijan Tawakol, MD, Julien Gaudric, MD, Ana Natário, MD, Gilbert Franco, MD, Luc Turmel-Rodrigues, MD, Olivier Van Laere, MD, Alain Raynaud, MD Journal of Vascular Surgery Volume 50, Issue 2, Pages 369-374.e1 (August 2009) DOI: 10.1016/j.jvs.2009.03.009 Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 1 Preoperative color duplex ultrasonography: transversal (left panel) and wrist to elbow (from top to bottom) longitudinal (right panel) imaging of subcutaneous tissues and vein. The double head arrows indicate the skin-to-vein distance above 5 mm. Journal of Vascular Surgery 2009 50, 369-374.e1DOI: (10.1016/j.jvs.2009.03.009) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 2 Operating diagram shows the arm (a) before, (b) during, and (c) after lipectomy. 1, skin; 2, fat; 3, fascia superficialis; 4, vein. Journal of Vascular Surgery 2009 50, 369-374.e1DOI: (10.1016/j.jvs.2009.03.009) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 3 Operative view shows one incision and the freshly removed fat pad (*). Journal of Vascular Surgery 2009 50, 369-374.e1DOI: (10.1016/j.jvs.2009.03.009) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 4 Postoperative view at 3 years shows the access creation incision (1), and the lipectomy incisions (2 and 3). Journal of Vascular Surgery 2009 50, 369-374.e1DOI: (10.1016/j.jvs.2009.03.009) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

Fig 5 Kaplan-Meier curves of primary (solid line) and secondary patency (dashed line) rates of all fistulas after lipectomy, with numbers of patients at risk (standard errors < 10%). Journal of Vascular Surgery 2009 50, 369-374.e1DOI: (10.1016/j.jvs.2009.03.009) Copyright © 2009 Society for Vascular Surgery Terms and Conditions