Saving a brachiocephalic fistula using lipectomy.

Many studies have demonstrated that functioning AVFs provide better vascular access outcomes compared to prosthetic devices. In April 2004, the Centers for Medicare and Medicaid Services (CMS) launched a "safe vascular access through collaborative fistula first initiative" (CMS, 2004). This breakthrough proposal cites studies that show increased mortality in patients who do not dialyze with a fistula. Veins too deep for needle cannulation are usually free of scars from intravenous (IV) sticks and, thus, are excellent options for fistula creation. Lipectomy can remove barriers, such as vein depth and limb obesity, creating an opportunity to have a functioning fistula.