Abstract
The rising prevalence of obesity is a well known global prob-lem, as is the relationship between obesity and end stage renaldisease (ESRD). Even though the best treatment for ESRD iskidney transplantation, haemodialysis, which depends onvascular access, is a key element in the management of ESRD.Thefirst line haemodialysis option with the best short and longterm results is the creation of native arteriovenous access(arteriovenousfistula, AVF).
Unfortunately, obese patients withESRD are higher risk of unsuccessful AVF creation due tomaturation problems associated with deep veins.1For thisreason, vascular access surgeons often use prosthetic grafts inobese patients in preference over autologous veins. Moreover,long termfistula patency is worse in the obese than in the non-obese population, with a higher secondary failure rate resultingin cannulation related complications.2Even though the current ESVS guidelines don't strictly definea level of body mass index that is a contraindication tofistulacreation, a primary or secondary surgical procedure to facilitatecannulation has been advocated by the European Society forVascular Surgery.3Invasive surgical procedures include eleva-tion or transposition of the arterialised vein or lipectomy.
Allthe aforementioned techniques need long skin incisions,venous dissection, ligation of venous tributaries, and areassociated with a higher risk of wound complications.The new concept of a mini-invasive approach has been pre-sented by Zeindleretal. in the paper"Endoscopic super-ficialisation of haemodialysis arteriovenousfistulas in obesepatientsesafety, feasibility and outcomes".