LAUSR

Superficialization of an AVF as second stage procedure by means of flap elevation (1) and open lipectomy (2), have been shown to be effective yet invasive options to prepare the cephalic vein for needling in obese patients. Previous attempts of minimally invasive procedures, such as ultrasoundguided liposuction (3), were shown to be associated with wound necrosis and large hematomas. Therefore, based on endoscopic surgery for hernia repair and following the technique of endoscopic basilic vein transposition (4), we developed a superficialization technique to obtain AVF function that allows visual control of the vein during the entire procedure. This minimizes the risk of vein injury and allows identifying other anatomical structures such as superficial fascia and tributaries. Endoscopic surgery for superficialization and closing of tributaries over a deep lying AVF has not been previously described. The novel technique renders revision and superficialization safer, as it reduces the risk of vein injury without prolonging the procedure. Furthermore, this minimally invasive technique avoids long skin scars, and provides excellent functional and aesthetic results.