Vascular access for hemodialysis by arteriovenous fistula (AVF) is broadly recommended.  Vein depth in many obese patients makes cannulation of an otherwise successful AVF difficult or impossible.  We reviewed the case of an obese patient where liposuction was used to remove adipose tissue resulting in a superficial and easily accessed AVF.  An endoscopic vein harvesting device was used to shield the vein during liposuction.