Keywords
hemodialysis
fistula theft
ischemia associated with dialysis fistula
How to Cite
Abstract
Treating upper limb ischemia or dialysis access-associated steal syndrome (DASS) is controversial. Many treatments have been described for this pathology; one of the techniques of preference in our institution is banding with the technique described by Miller et al. of minimally invasive endoluminal-assisted limited ligation revision (MILLER), in which we have modified to avoid the intercurrences it causes.
Four cases of stage II steal are presented in which the Miller technique is performed in which, instead of banding with a 2-0 Prolene suture, it is surrounded with a 1 cm wide PTFE segment. An angioplasty balloon is used to calibrate the desired diameter of the banding, and a Doppler ultrasound is performed to evaluate the flow before and after the procedure, as in the Miller technique.
The procedure allowed ischemia to be resolved, and the fistulas were found to be permeable without evidence of the complications usually described.
References
Miller GA, Goel N, Friedman A, Khariton A, Jotwani MC, Savransky Y, Khariton K, Arnold WP, Preddie DC. The MILLER banding procedure is an effective method for treating dialysis-associated steal syndrome. Kidney Int. 2010 Feb;77(4):359-66.
Mallios A, Lucas J 3rd, Jennings W. A mechanism of banding failure in excessively dilated fistulas. J Vasc Access. 2018 Jan;19(1):98-100. https://doi.org/10.5301/jva.5000769. PMID: 28777410.
Ladenheim ED. Failed MILLER Banding Complicated by Pseudoaneurysm: Report of a Case. Semin Dial. 2015 Jul-Aug;28(4):450-2.
Morsy AH, Kulbaski M, Chen C et al. Incidence and characteristics of patients with hand ischemia after a hemodialysis access procedure. J Surg Res 1998; 74: 8–10.
Beathard GA, Spergel LM. Hand ischemia associated with dialysis vascular access: an individualized access flow-based approach to therapy. Semin Dial. 2013 May-Jun;26(3):287-314.
Cheun TJ, Jayakumar L, Sideman MJ, Pounds LL, Davies MG. Upper extremity arterial endovascular interventions for symptomatic vascular access-induced steal syndrome. J Vasc Surg. 2019 Dec;70(6):1896-1903.e1.https://doi.org/10.1016/j.jvs.2019.01.072. Epub 2019 May 21. PMID: 31126767.
Ahearn DJ, Maher JF. Heart failure as a complication of hemodialysis arteriovenous fistula. Ann Intern Med. 1972 Aug;77(2):201-4.
Ebeid A, Saranchak HJ. Banding of a PTFE hemodialysis fistula in the treatment of steal syndrome. Clin Exp Dial Apheresis. 1981;5(3):251-7.
Murray BM, Rajczak S, Herman A et al. Effect of surgical banding of a high-flow fistula on access flow and cardiac output: intraoperative and long-term measurements. Am J Kidney Dis 2004; 44: 1090–1096.
Schanzer H, Schwartz M, Harrington E, Haimov M. Treatment of ischemia due to "steal" by arteriovenous fistula with distal artery ligation and revascularization. J Vasc Surg. 1988 Jun;7(6):770-3.
Zanow J, Kruger U, Scholz H. Proximalization of the arterial inflow: a new technique to treat access-related ischemia. J Vasc Surg. 2006 Jun;43(6):1216-21.
Minion DJ, Moore E, Endean E. Revision using distal inflow: a novel approach to dialysis-associated steal syndrome. Ann Vasc Surg. 2005 Sep;19(5):625-8. https://doi.org/10.1007/s10016-005-5827-7. PMID: 16052391.