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Obesity Does Not Impact Early Outcomes Of Endoscopic Assisted Arterio-venous Fistula Creation
Ghaith Almhanni, M.D., Indrani Sen, M.B.B.S., Shaun Marczak, PA-C, Kirk Herzog, PA-C, Mark Twesme, PA-C, Thomas Carmody, M.D., Tiziano Tallarita, M.D..
Mayo Clinic Health System, Eau Claire, WI, USA.

Objectives: Endoscopic vein harvest remains underutilized in single stage arteriovenous fistula (AVF) creation. We analyzed our results of the use of this technique in a cohort of predominantly obese (BMI > 30) patients. Methods: Demographics, intraoperative details and outcomes of all consecutive patients who underwent single stage endoscopic assisted AVF creation between 2020 and 2022 at a single institute were analyzed retrospectively. Primary outcomes were technical success, fistula maturation and patency. Results: There were 13 patients (8 males, mean age 64 12 years), 9 (70%) were on already dialysis at referral. The median BMI was 347, 70% were obese, an additional 22% were overweight. Medical comorbidities included hypertension in 13 (100%), diabetes and smoking in 9 (70%) each. A brachio-basilic AVF was created in 11(84%), brachiocephalic with cephalic vein superficialization in 1 (8%), and radio-cephalic with cephalic vein transposition in 1 (8%) patient. Operative success was 100%, there were no intraoperative complications. The median operative time was 308 minutes. Immediate postoperative complications (2 patients) included loss of thrill requiring division of a bridge of tethering tissue, and ligation of a bleeding venous side branch. The maturation rate was 100% and the AVF was successfully accessed in all patients who required dialysis (Figure 1). At an overall median clinical follow-up of 18 months, primary assisted and secondary patency were 918.7% and 100%, respectively. Reintervention in 9 patients included successful angioplasty in 6, thromboembolectomy in 2 and aneurysm resection with interposition graft in 1 patient. Conclusions: Endoscopic vein harvest can be used for single stage AVF creation with good technical success and favorable maturation and patency rates, even in obese patients.


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