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Lipectomy and liposuction are mostly utilized for patients with obesity as a surgical revision to improve routine cannulability. These procedures avoid the tunnel transposition- or elevation-related adverse events attributable to the impairment of the venous wall and configuration or superimposition of the scar. The substantial durability and safety of lipectomy to superficialize the deep arterialized forearm cephalic vein after creation of a radiocephalic fistula were demonstrated by Bourquelot et al. [24] in a single-center prospective study of 49 consecutive patients. Several reports have suggested the feasibility of ultrasound-guided liposuction to reduce the subcutaneous adipose tissue overlying the planned cannulation segments of the AVF, but this procedure is yet to be studied in a large series [25].