Journal of Vascular Surgery
Volume 50, Issue 2 , Pages 369-374.e1 , August 2009

Lipectomy as a new approach to secondary procedure superficialization of direct autogenous forearm radial-cephalic arteriovenous accesses for hemodialysis

  • Pierre Bourquelot, MD

      Affiliations

    • Clinique Jouvenet, Paris, France
    • Dialysis Access Specialists, LLC, Interventional Nephrology, Miami, Fla
    • Centre Hospitalier Universitaire La Pitié-Salpétrière, Paris, France
    • Centro Hospitalar Setúbal E.P.E., Setúbal, Portugal
    • Clinique Arago, Paris, France
    • Centre Médico-Chirurgical Ambroise Paré, Neuilly sur Seine, France
    • Corresponding Author InformationReprint requests: Pierre Bourquelot, MD, Vascular Access Department, Clinique Jouvenet, 6 Square Jouvenet, 75016 Paris, France
    • ,
  • Jan Bijan Tawakol, MD

      Affiliations

    • Dialysis Access Specialists, LLC, Interventional Nephrology, Miami, Fla
    • ,
  • Julien Gaudric, MD

      Affiliations

    • Centre Hospitalier Universitaire La Pitié-Salpétrière, Paris, France
    • ,
  • Ana Natário, MD

      Affiliations

    • Centro Hospitalar Setúbal E.P.E., Setúbal, Portugal
    • ,
  • Gilbert Franco, MD

      Affiliations

    • Clinique Arago, Paris, France
    • ,
  • Luc Turmel-Rodrigues, MD

      Affiliations

    • Centre Médico-Chirurgical Ambroise Paré, Neuilly sur Seine, France
    • ,
  • Olivier Van Laere, MD

      Affiliations

    • Clinique Jouvenet, Paris, France
    • Dialysis Access Specialists, LLC, Interventional Nephrology, Miami, Fla
    • Centre Hospitalier Universitaire La Pitié-Salpétrière, Paris, France
    • Centro Hospitalar Setúbal E.P.E., Setúbal, Portugal
    • Clinique Arago, Paris, France
    • Centre Médico-Chirurgical Ambroise Paré, Neuilly sur Seine, France
    • ,
  • Alain Raynaud, MD

      Affiliations

    • Hôpital Européen Georges Pompidou, Paris, France

Received 3 January 2009 ,Accepted 11 March 2009.

  • Image Result

    Preoperative color duplex ultrasonography: transversal (left panel) and wrist to elbow (from top to bottom) longitudinal (right panel) imaging of subcutaneous tissues and vein. The double head arrows

    Preoperative color duplex ultrasonography: transversal (left panel) and wrist to elbow (from top to bottom) longitudinal (right panel) imaging of subcutaneous tissues and vein. The double head arrows indicate the skin-to-vein distance above 5 mm.

  • Image Result
    Operating diagram shows the arm (a) before, (b) during, and (c) after lipectomy. 1, skin; 2, fat; 3, fascia superficialis; 4, vein.

    Operating diagram shows the arm (a) before, (b) during, and (c) after lipectomy. 1, skin; 2, fat; 3, fascia superficialis; 4, vein.

  • Image Result
    Operative view shows one incision and the freshly removed fat pad (*).

    Operative view shows one incision and the freshly removed fat pad (*).

  • Image Result
    Postoperative view at 3 years shows the access creation incision (1), and the lipectomy incisions (2 and 3).

    Postoperative view at 3 years shows the access creation incision (1), and the lipectomy incisions (2 and 3).

  • Image Result
    Kaplan-Meier curves of primary (solid line) and secondary patency (dashed line) rates of all fistulas after lipectomy, with numbers of patients at risk (standard errors < 10%).

    Kaplan-Meier curves of primary (solid line) and secondary patency (dashed line) rates of all fistulas after lipectomy, with numbers of patients at risk (standard errors < 10%).

 This study was made possible by the financial support of the Société Française de l'Abord Vasculaire (SFAV).

 Competition of interest: none.

 Additional material for this article may be found online at www.jvascsurg.org.

PII: S0741-5214(09)00662-4

doi: 10.1016/j.jvs.2009.03.009

Journal of Vascular Surgery
Volume 50, Issue 2 , Pages 369-374.e1 , August 2009

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