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Efficacy and comparison of elevation transposition and lipectomy for superficialization of cephalic arteriovenous fistula veins.
- Source :
-
The journal of vascular access [J Vasc Access] 2018 Jul; Vol. 19 (4), pp. 350-357. Date of Electronic Publication: 2018 Mar 15. - Publication Year :
- 2018
-
Abstract
- Objective: Substantial percentages of cephalic arteriovenous fistulas are situated too deep and require superficialization before use for hemodialysis. The superficialization techniques are diverse: tunnel transposition, elevation, elevation transposition, and lipectomy. Since the fistula veins are not mobilized during lipectomy, it is believed that lipectomy produces better outcomes than other techniques. However, no available report directly compares lipectomy with other techniques. The objective of this report is to compare the outcomes of cephalic elevation transposition with lipectomy.<br />Methods: The clinical data of patients who underwent second-stage cephalic elevation transposition or lipectomy at an ambulatory surgery center from 2009 to 2017 were analyzed ( n = 153).<br />Results: Comparing the cephalic elevation transposition group ( n = 125) with the lipectomy group ( n = 28), the mean body mass index was 36.8 ± 7.6 versus 38.1 ± 7.2 ( p = 0.41); the percentage of upper arm fistulas was 84% versus 61% ( p < 0.01); the mean follow-up was 20.1 ± 17.5 versus 38.6 ± 24.4 months ( p < 0.01); the primary patency rates of the whole fistula conduits were 42% versus 50% at 1 year ( p = 0.08); the secondary patency rates were 99% versus 100% at 1 year ( p = 0.22); the primary patency rates of the superficialized vein segments were 73% versus 68% at 1 year ( p = 0.72); and the mean number of percutaneous interventions required for the superficialized vein segments was 0.49 ± 1.10 versus 0.43 ± 0.71 per access-year ( p = 0.74).<br />Conclusion: Cephalic elevation transposition and lipectomy are both reliable techniques for superficialization of cephalic fistula veins and their outcomes are comparable.
- Subjects :
- Adult
Aged
Ambulatory Surgical Procedures adverse effects
Arteriovenous Shunt, Surgical adverse effects
Female
Graft Occlusion, Vascular etiology
Graft Occlusion, Vascular physiopathology
Graft Occlusion, Vascular therapy
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Risk Factors
Time Factors
Treatment Outcome
Vascular Patency
Veins physiopathology
Ambulatory Surgical Procedures methods
Arteriovenous Shunt, Surgical methods
Lipectomy adverse effects
Renal Dialysis
Upper Extremity blood supply
Veins surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1724-6032
- Volume :
- 19
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- The journal of vascular access
- Publication Type :
- Academic Journal
- Accession number :
- 29926786
- Full Text :
- https://doi.org/10.1177/1129729818757709