Lipectomia como alternativa de superficialização de fístula arteriovenosa autóloga em pacientes obesos: a experiência de um centro de referência na Amazônia
Lipectomy as an alternative for superficialization of autologous AVF in obese patients: experience of a referral center in Amazon
José Maciel Caldas dos Reis; Flávio Roberto Cavalleiro de Macêdo Ribeiro; Glauco dos Santos Melo; Humberto Balbi Reale Neto; Mariseth Carvalho de Andrade
Resumo
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Abstract
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.
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Referências
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Submetido em:
06/04/2023
Aceito em:
06/01/2024
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