Abstract: TH-PO770
Tailored Selection of Elevation Transposition and Lipectomy for Superficialization of Cephalic Arteriovenous Fistula Veins
Session Information
- Hemodialysis: Vascular Access - I
November 02, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Dialysis
- 603 Hemodialysis: Vascular Access
Author
- Wang, Shouwen, Arizona Kidney Disease and Hypertension Center, Phoenix, Arizona, United States
Background
Cephalic vein arteriovenous fistulas are the most commonly used vascular accesses for hemodialysis. However, as high as 34% of these fistulas are situated too deep under the skin and require superficialization before use. Various superficialization techniques have been employed, such as tunnel transposition, elevation, elevation transposition, and lipectomy. Each of these techniques may have advantages and disadvantages, and there have been few reports comparing their outcomes. This report compares the clinical outcomes of cephalic elevation transposition (CET) vs lipectomy and discusses tailored selection of these techniques.
Methods
The clinical data of patients who underwent second-stage cephalic vein elevation transposition or lipectomy at an ambulatory surgery center were collected and analyzed. The patients who underwent basilic elevation transposition (BET) were included for comparison with CET.
Results
A total of 240 patients were included. Comparing the CET group (n=118) vs the lipectomy group (n=28) vs the BET group (n=94): males were 28% vs 32% vs 59%; the mean age was 58.0±14.1 vs 56.3±12.1 vs 60.0±15.0; the mean body mass index was 36.9±7.8 vs 38.1±7.2 vs 26.8±6.9; the percentages of upper arm fistulas were 84% vs 61% vs 100% and of the forearm fistulas were 16% vs 39% vs 0%; and the mean follow-up was 18.8±17.6 vs 37.1±24.4 vs 24.6±20.0 months. For the CET vs the lipectomy vs the BET groups, the primary patency rates of the whole fistula conduit were 40% vs 49% vs 44% at one year and 17% vs 37% vs 37% at three years; the assisted primary patency rates were 93% vs 96% vs 97% at one year and 78% vs 96% vs 88% at three years; the secondary patency rates were 99% vs 100% vs 100% at one year and 92% vs 100% vs 98% at three years; the primary patency rates of the superficialized fistula vein segments were 72% vs 67% vs 65% at one year and 57% vs 51% vs 53% at three years; and the mean numbers of percutaneous interventions required for the superficialized fistula vein segments were 0.55±1.10 vs 0.43±0.71 vs 0.60±1.02 per access-year.
Conclusion
CET and lipectomy are reliable approaches for superficialization of cephalic fistula veins that yield high cumulative fistula survival rates, which are comparable to that of BET for basilic fistula veins. The selection of CET or lipectomy is mainly based on the location and depth of a fistula vein.