VS3. Video Presentation Superficialization of Arteriovenous Fistulas Employing Minimally Invasive Liposuction

Abstract

Superficialization of arteriovenous fistulas (AVFs) allow improved dialysis access for prolonged utilization and more efficient dialysis treatment. Multiple methods are described for superficializing arteriovenous fistulas and minimizing the surgical intervention is advantageous for patient recovery and potentially improved outcomes. We describe a novel technique employing a minimally invasive technique, liposuction, with the use of ultrasonography to ensure the safety of the AVF. After identifying the AVF using B mode duplex, tumescent anesthesia was administered under ultrasound guidance between the fistula and subcutaneous tissues. After a short period of time (5 minutes) is allowed for epinephrine induced vasoconstriction to occur and a 2 mm aspiration cannula is then inserted under ultrasound guidance. Continuous aspiration on the syringe is performed with the cannula in constant motion in a radial pattern above the arteriovenous fistula under direct ultrasound guidance. This direct ultrasound mapping and guidance minimizes potential complications, such as injury to the fistula or disruption of small tributary veins. This technique is performed on the overlying adipose tissue until the fistula was easily palpable and visible pulsations were noted underneath the skin. After thinning the tissue, the fistula was examined using B mode duplex to ensure no injury, pseudoaneurysm, or extravasation and spectral duplex to confirm adequate flow through the fistula.