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Superficialization of arteriovenous fistulae employing minimally invasive liposuction  Marlin Wayne Causey, MD, Reagan Quan, MD, Adam Hamawy, MD, Niten.

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Presentation on theme: "Superficialization of arteriovenous fistulae employing minimally invasive liposuction  Marlin Wayne Causey, MD, Reagan Quan, MD, Adam Hamawy, MD, Niten."— Presentation transcript:

1 Superficialization of arteriovenous fistulae employing minimally invasive liposuction 
Marlin Wayne Causey, MD, Reagan Quan, MD, Adam Hamawy, MD, Niten Singh, MD  Journal of Vascular Surgery  Volume 52, Issue 5, Pages (November 2010) DOI: /j.jvs Copyright © Terms and Conditions

2 Fig 1 Technical description of upper extremity liposuction superficialization. Step 1 (A): Identify the arteriovenous fistula using B mode duplex and mark the overlying skin. Step 2: Perform subcutaneous tumescence using mL of 1% lidocaine with 1:100,000 units of epinephrine in a bag of lactated Ringer's solution (to ensure 2-cm distance between the fistula and overlying skin). After infiltration of appropriate tumescence, wait 5 minutes for epinephrine-induced vasoconstriction. Step 3: Create a stab incision 1 cm proximal to the anticubital fossa. Step 4 (B): Insert the 2-mm adipose suction cannula under ultrasound guidance performing the suction lipectomy in a radial fashion above the arteriovenous fistula. Step 5 (C): After thinning the tissue (to the point where the fistula is easily palpable and visible pulsations are noted), examine the fistula under ultrasound using B mode to ensure no injury, pseudoaneurysm, or extravasation and spectral duplex to ensure adequate flow through the fistula (D). Step 6: Close the small incision and wrap the upper arm with a 6-inch pressure bandage, having the patient remove the bandage on postoperative day number 2 (E, video). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © Terms and Conditions

3 Fig 2 Differences in depth of arteriovenous fistula before and after suction lipectomy. Ultrasound images are before on the left and after on the right at the same level. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © Terms and Conditions

4 Fig 3 Algorithm for overall management of patients deemed candidates for liposuction superficialization of upper extremity arteriovenous fistulae. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © Terms and Conditions

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