When XXXX Are Too Deep: Options in Obese Individuals.

@entity1 @entity2548 @entity6 @entity28
BACKGROUND: Obesity in the hemodialysis population is roughly twice that of the general population. An @entity2548 ( @entity2548 ) remains the recommended vascular access; however, @entity28 results in fewer autogenous accesses, more complexity, and higher @entity2548 failure rates. We reviewed our vascular access experience in @entity28 individuals in whom the depth of an @entity2548 prevented reliable cannulation. STUDY DESIGN: We reviewed our database of consecutive vascular access @entity1 , identifying individuals in whom the planned venous outflow cannulation segments were too deep and required additional surgical procedures to establish a functional hemodialysis access. These additional procedures included lipectomy, outflow elevation, cephalic transposition, liposuction, or an implantable cannulation guide. RESULTS: During the study period, 1,874 consecutive new @entity1 had an autogenous vascular access constructed. We identified 120 @entity1 in whom an additional procedure was required due to the depth of the cannulation sites; these comprised this study group. Ninety-nine (83%) were female, 85 (71%) were @entity6 , and 53 (45%) had previous access operations. Body mass index was 25.4 to 62.8 kg/m(2) (mean 40.8 kg/m(2)), age range was 27 to 81 years (mean 54 years), and follow-up was 1 to 101 months (mean 25 months). Primary and cumulative patency rates for all @entity1 were 63% and 93% at 1 year and 46% and 91% after 2 years, respectively. The most common additional procedure performed was a lipectomy (n  = 78), with 1-year primary and cumulative patency rates of 78% and 97% and 2-year rates of 69% and 91%, respectively. CONCLUSIONS: A variety of surgical options were found to be successful in establishing a functional autogenous vascular access for individuals in whom cannulation sites were simply too deep. Cumulative patency rates for all @entity1 were 93% at 1 year and 91% after 2 years.
