TARGETED LIPOSUCTION FOR VESSEL SUPERFICIALIZATION TO FACILITATE ARTERIOVENOUS FISTULA CREATION IN AN OBESE PATIENT: A CASE REPORT

Abstract

Background: Arteriovenous fistula (AVF) is the preferred form of permanent vascular access for long-term hemodialysis. In patients with obesity, excessive subcutaneous adipose tissue may place otherwise suitable vessels at a depth that makes identification and subsequent cannulation difficult. Surgical superficialization is effective but may require extensive dissection. Targeted liposuction offers a minimally invasive option for reducing the skin-to-vessel distance in selected patients. Case Presentation A 60-year-old woman with obesity, right upper-limb ptosis, and chronic kidney disease was referred for vascular access creation for hemodialysis. Clinical examination was limited by redundant soft tissue and difficulty in identifying the superficial vascular structures. Preoperative ultrasonography demonstrated a suitable target vessel at a depth of approximately 1.17 cm from the skin surface. After multidisciplinary assessment, targeted minimally invasive liposuction of the upper arm was performed over the mapped vascular structures. Post-procedure ultrasonography demonstrated reduction of the vessel depth to approximately 0.6 cm. A brachial artery–cephalic vein arteriovenous fistula was subsequently created on the second postoperative day. Results The procedure was completed without reported immediate complications. Reduction in the overlying adipose tissue facilitated identification and access to the target vessels. The patient subsequently had a functioning AVF suitable for hemodialysis. A visible reduction in arm ptosis and improvement in upper-limb contour were also noted. Conclusion Targeted liposuction may be a useful minimally invasive adjunct for superficialization of suitable vascular structures in selected obese patients requiring hemodialysis access. Further experience with standardized long-term assessment of AVF maturation, cannulation, and patency is required.