“Fistulae in the obese often fail to mature or prove inadequate to needle due to excessive depth (gt;6 mm). This study is a summary of our experience with brachio and radio-cephalic vein superficialisation in the obese.” Evans et al (2014).
Evans, R.P., Meecham, L., Buxton, P., Jafferbhoy, S., Legge, J., Papp, L., Ehsan, O. and Pherwani, A.D. (2014) Vascular access in the obese: superficialisation of native radio-cephalic and brachio-cephalic fistulae. The Journal of Vascular Access. October 16th. .
PURPOSE: The Department of Health estimates that currently in the UK, 61.3% of the population are overweight or obese (BMI gt;25 kg/m2). Fistulae in the obese often fail to mature or prove inadequate to needle due to excessive depth (gt;6 mm). This study is a summary of our experience with brachio and radio-cephalic vein superficialisation in the obese.
METHODS: From May 2008 to October 2012, 22 patients underwent superficialisation of the cephalic vein following radio-cephalic or brachio-cephalic Arterio-venous fistula (AVF) creation. Data were obtained from a prospective database (Cyberen®) and retrospectively analysed.
RESULTS: The study included 23 AVFs in 22 patients (seven males, 15 females), of which 13 were brachio-cephalic and 10 radio-cephalic. The mean age of the patients was 56 years (median 60, range 19-78 years). The mean BMI was 36.7 kg/m2 (median 32, 25-58 kg/m2). Six-week post procedure duplex ultrasonography recorded the mean fistula depth to be 7.7 mm (median 8 mm, 5-15 mm) and mean flow rates were 961 ml/min (median 800 ml/min, 320-1968 ml/min).Of the 23, 21 fistulae matured successfully. There were no procedure-related complications. During follow-up, two patients underwent transplantation prior to fistula use and three patients died of unrelated causes. The remaining 16 fistulae remain in use and under access surveillance.
CONCLUSIONS: Superficialisation of brachio/radio-cephalic fistulae is an excellent option to optimise the cephalic vein for needling, assisting primary patency. Superficialisation of the cephalic vein helps maintain long-term functional access in overweight and obese patients.
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