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Percutaneous dialysis arteriovenous fistula banding for flow reduction – a case series

Percutaneous dialysis arteriovenous fistula banding for flow reduction – a case series Introduction: Arteriovenous fistulas (AVF) are the preferred method of vascular access for chronic haemodialysis. However, excess shunting through the AVF can result in dialysis-access steal syndrome (DASS) or high-output cardiac failure. Percutaneous AVF banding is a minimally-invasive technique for treating DASS with good short-intermediate term results. Materials and methods: We review a case series of percutaneous AVF banding procedures for DASS and high-output cardiac failure to illustrate the technique and limitations of this technique. Results: Two representative cases from our local experience were selected to illustrate the technique in a stepwise manner. Both cases were performed for DASS, with good technical success. However, clinical success was limited in one case due to underlying arterial insufficiency. The technique, selection of appropriate banding diameter for flow reduction, limitations and complications of alternative surgical techniques are discussed. Conclusions: Percutaneous AVF banding is a relatively straightforward and effective minimally-invasive technique for treatment of DASS supported by short-intermediate term data. Introduction ligation, distal revascularisation and interval ligation Arteriovenous fistulas (AVF) are the preferred method (DRIL) and revision using distal inflow (RUDI) (Gupta of vascular access for patients on chronic haemodialysis. et al. 2011). However, procedures such as surgical banding Common AVF types encountered in practice include the can potentially result in loss of vascular access for haemo- radiocephalic, brachiocephalic and brachiobasilic fistulas dialysis all together and the invasive nature of these proce- (Vascular Access Work G 2006). Occasionally, synthetic dures are associated with a relatively high rate of polytetrafluoroethylene arteriovenous grafts (AVG) are complications, ranging between 30 and 50% in one surgical utilised when there are no suitable veins to form an au- series (Leake et al. 2015). Percutaneous endovascular band- tologous conduit. Excess shunting through the AVF can ing, also known as Minimally Invasive Limited Ligation result in dialysis-access steal syndrome (DASS) leading Endoluminal-assisted Revision (MILLER) has been de- to distal ischaemia or high-output cardiac failure when scribed as a less-invasive fistula reduction technique for severe. This risk is estimated to be approximately 1% in DASS (Goel et al. 2006), and in this article, we present a AVF and between 4 and 5% in AVG (Goel et al. 2006). technical review of the procedure and discuss situations Symptoms and signs of DASS may include pain, pallor, where percutaneous banding may have limited success. paraesthesia, weakness and necrosis of the distal extrem- ity and digits in severe cases. Materials and methods A number of treatment options are available for DASS We present two cases in which AVF banding was per- and traditionally involve surgical procedures such as formed for DASS and high-output cardiac failure. Fol- lowing written informed consent, all procedures were * Correspondence: julian.maingard@gmail.com performed under aseptic technique, in a dedicated inter- Department of Interventional Radiology, Austin Hospital, Melbourne, Australia ventional radiology suite under conscious sedation and Interventional Neuroradiology Service, Austin Hospital, Melbourne, Australia local anaesthesia. Full list of author information is available at the end of the article © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Kok et al. CVIR Endovascular (2018) 1:27 Page 2 of 5 Results She proceeded to undergo percutaneous AVF banding Case 1 using the same technique described in the case above A 50-year-old man on long term haemodialysis through a (Figs. 2d and e). However, despite successful flow reduc- left-sided brachiocephalic AVF presented with worsening tion through the AVF and some improvement of arterial pain and cyanosis in the left hand. The AVF had also be- flow to the level of the forearm, the distal perfusion to come progressively aneurysmal over the preceeding the hand remained poor due to underlying atheroscler- 2 months. Duplex ultrasound demonstrated non-occlusive osis with occlusion of the distal radial and ulnar arteries laminated thrombus in the aneurysmal outflow vein. The and absence of the palmar arch in the hand (Fig. 2f). distal radial and ulnar arterial pulses were weak with The tissue loss was managed conservatively and eventu- monophasic flow demonstrated on duplex assessment. A ally healed with associated soft tissue atrophy over a diagnostic fistulogram showed very rapid flow across the period of 8 weeks. AVF with an aneurysmal outflow limb but no distal out- flow or central venous stenosis (Fig. 1a). The juxtaanasto- Discussion motic venous limb measured 13 mm in maximum In patients with DASS, percutaneous AVF banding or diameter (Fig. 1b). MILLER is a useful and less-invasive alternative com- Percutaneous AVF banding was performed following pared to surgical ligation where there is the possibility of ultrasound-guided retrograde access into the cephalic ven- loss of vascular access, requiring transition to dialysis ous outflow limb with placement of a 6 French introducer catheters or pre-emptive creation of a new fistula. The sheath (Prelude; Merit Medical, South Jordan, UT). The technique for percutaneous AVF banding as described, is brachial artery inflow was retrogradely catheterised using relatively straightforward and potentially reversible with a 5 French angled KMP catheter (Cook, Bloomington, IN) angioplasty or stenting, if an absorbable suture is used and 0.035″ hydrophilic guidewire (Glidewire; Terumo, as in our series (Shukla et al. 2016). Results from larger Somerset, NJ) combination. Following this, a 5 × 40 mm cohorts show promising results with a primary patency angioplasty balloon (EverCross; Covidien, Plymouth, MN) rate of between 75 and 85% at 6 months with primary was placed across the venous outflow limb in the assisted patency rates of 92% at 1 year (Shukla et al. juxta-anastomotic region and inflated to nominal pressure 2016; Miller et al. 2010). Complications from percutan- using a mechanical inflation device (Fig. 1c). Two small eous banding are uncommon and mostly relate to fistula incisions were made on either side of the inflated balloon thrombosis or need for repeat banding to achieve ad- and blunt dissection was carefully performed superficial equate clinical success (Shukla et al. 2016; Miller et al. and deep to the outflow vein (Fig. 1d). 2010). Comparatively, surgical procedures including A2–0 braided absorbable suture (Vicryl; Ethicon, banding, DRIL and RUDI also demonstrate high fistula Somerville, NJ) was double looped, pulled through the preservation rates between 89 and 100%, highest for incision, below and above the waist of the inflated angio- DRIL procedures, but these were associated with a plasty balloon and secured (Fig. 1e to h) to create a sten- higher risk of early 30-day complications, particularly for osis in the outflow vein (Fig. 1i). Immediate post-banding surgical banding where there is an 11% risk of throm- duplex ultrasound showed reduced velocities in the out- bosis and 2.8% infection risk in the early postoperative flow vein. If there was no change on the immediate period (Leake et al. 2015). post-banding duplex study, the balloon can be exchanged The degree of juxtaanastomotic venous outflow reduc- for a smaller diameter balloon for creation of a smaller tion is determined by the luminal diameter reduction diameter band. In this case, there was complete resolution and is controlled by the diameter of the angioplasty bal- of DASS clinical symptoms and no issues related to dialy- loon used. Miller and other authors aimed for a band sis or AVF thrombosis 6 months following the procedure. size slightly less than the size of the downstream artery on the pre-reduction angiogram. We used a similar but Case 2 slightly more conservative estimate in our cases, aiming An 80-year-old female patient on long term haemodialy- for a balloon size under half of the juxtaanastomotic sis due to diabetic nephropathy presented with a venous diameter as the relationship between the band two-week history of left hand paraesthesia, weakness, ul- stenosis and arterial diameter can change following re- ceration and necrosis of her fingertips on the side of a distribution of flow. The risks of AVF thrombosis is left brachiocephalic AVF (Fig. 2a). The radial and ulnar higher with greater reduction of flow and in our opinion, arterial pulses were undetectable on clinical and duplex it is easier to repeat the banding procedure than salvage assessment. A diagnostic fistulogram was performed a thrombosed fistula. In the first case, the selection of a which demonstrated very brisk flow across the AVF with 5 mm balloon relative to a 13 mm segment resulted in poor opacification of the radial and ulnar arteries in the an approximate angiographic stenosis of 75% (Fig. 1i). forearm (Figs. 2b and c). Banding can also be guided by intraprocedural flow Kok et al. CVIR Endovascular (2018) 1:27 Page 3 of 5 Fig. 1 a Retrograde percutaneous access was obtained through the venous outflow limb of the brachiocephalic AVF and a 6-French sheath was placed. b A guidewire is negotiated across the anastomosis retrogradely into the inflow brachial artery and the juxta-anastomotic venous outflow limb diameter is measured at 13 mm (arrow). c Following this, a 5 × 40 mm angioplasty balloon was inflated to nominal pressure and (d) blunt dissection was performed carefully on either side of the venous outflow limb. e-h The venous outflow limb was stenosed to the profile of the inflated balloon using a constraining 2–0 suture. i Completion fistulogram showing stenosis in the outflow vein (black arrow) and improvement in perfusion of the brachial artery distal to the anastomosis (white arrow) as well as to the hand Kok et al. CVIR Endovascular (2018) 1:27 Page 4 of 5 Fig. 2 a Evidence of steal syndrome with associated tissue ulceration at the fingertips. b Diagnostic fistulogram performed through a catheter placed in the inflow brachial artery shows rapid shunting of flow across the AVF into the outflow cephalic vein (arrows indicating flow direction). The radial and ulnar arteries in the forearm are poorly opacified. c Percutaneous AVF banding was performed over a 5 × 40 mm angioplasty balloon with (d) a stenosis created in the outflow vein (black arrow). Perfusion to the forearm was improved but the distal radial and ulnar arteries (white arrows) were occluded secondary to underlying atherosclerosis and the perfusion to the hand did not improved significantly in this case Kok et al. CVIR Endovascular (2018) 1:27 Page 5 of 5 measurements but these require additional flow trans- Publisher’sNote Springer Nature remains neutral with regard to jurisdictional claims in published ducer devices for measurement. Banding to a predeter- maps and institutional affiliations. mined luminal reduction of approximately 75% appears to be safe, equally effective and reduces the need for add- Author details Department of Interventional Radiology, Beaumont Hospital, Dublin, Ireland. itional costly equipment in most cases (Shukla et al. 2016). Department of Radiology, Royal College of Surgeons in Ireland, Dublin, Successful percutaneous AVF banding depends on the 3 Ireland. Department of Interventional Radiology, Austin Hospital, Melbourne, exclusion of other confounding causes for DASS symp- Australia. Interventional Neuroradiology Service, Austin Hospital, Melbourne, Australia. School of Medicine, Faculty of Health, Deakin University, Geelong, toms, particularly arterial insufficiency as illustrated in the VIC, Australia. second case. Often, it can be difficult to confidently exclude distal arterial disease on non-invasive assessment because Received: 24 July 2018 Accepted: 16 October 2018 of the excess shunting and resultant poor distal perfusion prior to banding due to the small calibre of the distal pal- References mar vessels and difficulties with optimal contrast timing on Goel N, Miller GA, Jotwani MC et al (2006) Minimally invasive limited ligation Endoluminal-assisted revision (MILLER) for treatment of dialysis access- CT angiography. Therefore, upper limb digital subtraction associated steal syndrome. Kidney Int 70(4):765–770 angiography with treatment of underlying arterial stenoses Gupta N, Yuo TH, Gt K et al (2011) Treatment strategies of arterial steal after prior to banding is essential for clinical success if there is arteriovenous access. J Vasc Surg 54(1):162–167 Leake AE, Winger DG, Leers SA, Gupta N, Dillavou ED (2015) Management and clinical concern for associated arterial disease (Shukla et al. outcomes of dialysis access-associated steal syndrome. J Vasc Surg 61(3):754–760 2016). In particular, revascularisation strategies should aim Miller GA, Goel N, Friedman A et al (2010) The MILLER banding procedure is an to restore adequate inflow to the palmar arch and digits, effective method for treating dialysis-associated steal syndrome. Kidney Int 77(4):359–366 particularly where tissue loss is of concern. Shukla PA, Kolber MK, Nwoke F et al (2016) The MILLER banding procedure as a treatment alternative for dialysis access steal syndrome: a single institutional experience. Clin Imaging 40(3):569–572 Conclusion Vascular Access Work G (2006) Clinical practice guidelines for vascular access. Am Percutaneous AVF banding is an effective and safe J Kidney Dis 48(Suppl 1):S176–S247 minimally-invasive technique for treatment of ischaemic DASS with good intermediate-term patency rates, com- parable to more invasive surgical procedures. However, there is a need for further studies to assess long-term outcomes including late thrombosis rates. Abbreviations AVF: Arteriovenous fistula; AVG: Arteriovenous grafts; DASS: Dialysis-access steal syndrome; DRIL: Distal revascularisation and interval ligation; MILLER: Minimally Invasive Limited Ligation Endoluminal-assisted Revision; RUDI: Revision using distal inflow Acknowledgements Not applicable. Funding No funding was obtained for this project. Availability of data and materials Data sharing not applicable to this article as no datasets were generated or analysed during the current study. Authors’ contributions HKK participated and performed the procedure and drafted the manuscript; JM, HA edited and drafted the manuscript; ER, MS, MFG, MJL participated and performed the procedure and drafted and edited the manuscript. All authors read and approved the final manuscript. Ethics approval and consent to participate An ethics waiver has been provided and patient consent for the procedures was obtained. Consent for publication The patients consented to publication of their cases. Competing interests The authors declare that they have no competing interests. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png CVIR Endovascular Springer Journals

Percutaneous dialysis arteriovenous fistula banding for flow reduction – a case series

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Springer Journals
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Copyright © 2018 by The Author(s)
Subject
Medicine & Public Health; Medicine/Public Health, general; Imaging / Radiology; Interventional Radiology
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Abstract

Introduction: Arteriovenous fistulas (AVF) are the preferred method of vascular access for chronic haemodialysis. However, excess shunting through the AVF can result in dialysis-access steal syndrome (DASS) or high-output cardiac failure. Percutaneous AVF banding is a minimally-invasive technique for treating DASS with good short-intermediate term results. Materials and methods: We review a case series of percutaneous AVF banding procedures for DASS and high-output cardiac failure to illustrate the technique and limitations of this technique. Results: Two representative cases from our local experience were selected to illustrate the technique in a stepwise manner. Both cases were performed for DASS, with good technical success. However, clinical success was limited in one case due to underlying arterial insufficiency. The technique, selection of appropriate banding diameter for flow reduction, limitations and complications of alternative surgical techniques are discussed. Conclusions: Percutaneous AVF banding is a relatively straightforward and effective minimally-invasive technique for treatment of DASS supported by short-intermediate term data. Introduction ligation, distal revascularisation and interval ligation Arteriovenous fistulas (AVF) are the preferred method (DRIL) and revision using distal inflow (RUDI) (Gupta of vascular access for patients on chronic haemodialysis. et al. 2011). However, procedures such as surgical banding Common AVF types encountered in practice include the can potentially result in loss of vascular access for haemo- radiocephalic, brachiocephalic and brachiobasilic fistulas dialysis all together and the invasive nature of these proce- (Vascular Access Work G 2006). Occasionally, synthetic dures are associated with a relatively high rate of polytetrafluoroethylene arteriovenous grafts (AVG) are complications, ranging between 30 and 50% in one surgical utilised when there are no suitable veins to form an au- series (Leake et al. 2015). Percutaneous endovascular band- tologous conduit. Excess shunting through the AVF can ing, also known as Minimally Invasive Limited Ligation result in dialysis-access steal syndrome (DASS) leading Endoluminal-assisted Revision (MILLER) has been de- to distal ischaemia or high-output cardiac failure when scribed as a less-invasive fistula reduction technique for severe. This risk is estimated to be approximately 1% in DASS (Goel et al. 2006), and in this article, we present a AVF and between 4 and 5% in AVG (Goel et al. 2006). technical review of the procedure and discuss situations Symptoms and signs of DASS may include pain, pallor, where percutaneous banding may have limited success. paraesthesia, weakness and necrosis of the distal extrem- ity and digits in severe cases. Materials and methods A number of treatment options are available for DASS We present two cases in which AVF banding was per- and traditionally involve surgical procedures such as formed for DASS and high-output cardiac failure. Fol- lowing written informed consent, all procedures were * Correspondence: julian.maingard@gmail.com performed under aseptic technique, in a dedicated inter- Department of Interventional Radiology, Austin Hospital, Melbourne, Australia ventional radiology suite under conscious sedation and Interventional Neuroradiology Service, Austin Hospital, Melbourne, Australia local anaesthesia. Full list of author information is available at the end of the article © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Kok et al. CVIR Endovascular (2018) 1:27 Page 2 of 5 Results She proceeded to undergo percutaneous AVF banding Case 1 using the same technique described in the case above A 50-year-old man on long term haemodialysis through a (Figs. 2d and e). However, despite successful flow reduc- left-sided brachiocephalic AVF presented with worsening tion through the AVF and some improvement of arterial pain and cyanosis in the left hand. The AVF had also be- flow to the level of the forearm, the distal perfusion to come progressively aneurysmal over the preceeding the hand remained poor due to underlying atheroscler- 2 months. Duplex ultrasound demonstrated non-occlusive osis with occlusion of the distal radial and ulnar arteries laminated thrombus in the aneurysmal outflow vein. The and absence of the palmar arch in the hand (Fig. 2f). distal radial and ulnar arterial pulses were weak with The tissue loss was managed conservatively and eventu- monophasic flow demonstrated on duplex assessment. A ally healed with associated soft tissue atrophy over a diagnostic fistulogram showed very rapid flow across the period of 8 weeks. AVF with an aneurysmal outflow limb but no distal out- flow or central venous stenosis (Fig. 1a). The juxtaanasto- Discussion motic venous limb measured 13 mm in maximum In patients with DASS, percutaneous AVF banding or diameter (Fig. 1b). MILLER is a useful and less-invasive alternative com- Percutaneous AVF banding was performed following pared to surgical ligation where there is the possibility of ultrasound-guided retrograde access into the cephalic ven- loss of vascular access, requiring transition to dialysis ous outflow limb with placement of a 6 French introducer catheters or pre-emptive creation of a new fistula. The sheath (Prelude; Merit Medical, South Jordan, UT). The technique for percutaneous AVF banding as described, is brachial artery inflow was retrogradely catheterised using relatively straightforward and potentially reversible with a 5 French angled KMP catheter (Cook, Bloomington, IN) angioplasty or stenting, if an absorbable suture is used and 0.035″ hydrophilic guidewire (Glidewire; Terumo, as in our series (Shukla et al. 2016). Results from larger Somerset, NJ) combination. Following this, a 5 × 40 mm cohorts show promising results with a primary patency angioplasty balloon (EverCross; Covidien, Plymouth, MN) rate of between 75 and 85% at 6 months with primary was placed across the venous outflow limb in the assisted patency rates of 92% at 1 year (Shukla et al. juxta-anastomotic region and inflated to nominal pressure 2016; Miller et al. 2010). Complications from percutan- using a mechanical inflation device (Fig. 1c). Two small eous banding are uncommon and mostly relate to fistula incisions were made on either side of the inflated balloon thrombosis or need for repeat banding to achieve ad- and blunt dissection was carefully performed superficial equate clinical success (Shukla et al. 2016; Miller et al. and deep to the outflow vein (Fig. 1d). 2010). Comparatively, surgical procedures including A2–0 braided absorbable suture (Vicryl; Ethicon, banding, DRIL and RUDI also demonstrate high fistula Somerville, NJ) was double looped, pulled through the preservation rates between 89 and 100%, highest for incision, below and above the waist of the inflated angio- DRIL procedures, but these were associated with a plasty balloon and secured (Fig. 1e to h) to create a sten- higher risk of early 30-day complications, particularly for osis in the outflow vein (Fig. 1i). Immediate post-banding surgical banding where there is an 11% risk of throm- duplex ultrasound showed reduced velocities in the out- bosis and 2.8% infection risk in the early postoperative flow vein. If there was no change on the immediate period (Leake et al. 2015). post-banding duplex study, the balloon can be exchanged The degree of juxtaanastomotic venous outflow reduc- for a smaller diameter balloon for creation of a smaller tion is determined by the luminal diameter reduction diameter band. In this case, there was complete resolution and is controlled by the diameter of the angioplasty bal- of DASS clinical symptoms and no issues related to dialy- loon used. Miller and other authors aimed for a band sis or AVF thrombosis 6 months following the procedure. size slightly less than the size of the downstream artery on the pre-reduction angiogram. We used a similar but Case 2 slightly more conservative estimate in our cases, aiming An 80-year-old female patient on long term haemodialy- for a balloon size under half of the juxtaanastomotic sis due to diabetic nephropathy presented with a venous diameter as the relationship between the band two-week history of left hand paraesthesia, weakness, ul- stenosis and arterial diameter can change following re- ceration and necrosis of her fingertips on the side of a distribution of flow. The risks of AVF thrombosis is left brachiocephalic AVF (Fig. 2a). The radial and ulnar higher with greater reduction of flow and in our opinion, arterial pulses were undetectable on clinical and duplex it is easier to repeat the banding procedure than salvage assessment. A diagnostic fistulogram was performed a thrombosed fistula. In the first case, the selection of a which demonstrated very brisk flow across the AVF with 5 mm balloon relative to a 13 mm segment resulted in poor opacification of the radial and ulnar arteries in the an approximate angiographic stenosis of 75% (Fig. 1i). forearm (Figs. 2b and c). Banding can also be guided by intraprocedural flow Kok et al. CVIR Endovascular (2018) 1:27 Page 3 of 5 Fig. 1 a Retrograde percutaneous access was obtained through the venous outflow limb of the brachiocephalic AVF and a 6-French sheath was placed. b A guidewire is negotiated across the anastomosis retrogradely into the inflow brachial artery and the juxta-anastomotic venous outflow limb diameter is measured at 13 mm (arrow). c Following this, a 5 × 40 mm angioplasty balloon was inflated to nominal pressure and (d) blunt dissection was performed carefully on either side of the venous outflow limb. e-h The venous outflow limb was stenosed to the profile of the inflated balloon using a constraining 2–0 suture. i Completion fistulogram showing stenosis in the outflow vein (black arrow) and improvement in perfusion of the brachial artery distal to the anastomosis (white arrow) as well as to the hand Kok et al. CVIR Endovascular (2018) 1:27 Page 4 of 5 Fig. 2 a Evidence of steal syndrome with associated tissue ulceration at the fingertips. b Diagnostic fistulogram performed through a catheter placed in the inflow brachial artery shows rapid shunting of flow across the AVF into the outflow cephalic vein (arrows indicating flow direction). The radial and ulnar arteries in the forearm are poorly opacified. c Percutaneous AVF banding was performed over a 5 × 40 mm angioplasty balloon with (d) a stenosis created in the outflow vein (black arrow). Perfusion to the forearm was improved but the distal radial and ulnar arteries (white arrows) were occluded secondary to underlying atherosclerosis and the perfusion to the hand did not improved significantly in this case Kok et al. CVIR Endovascular (2018) 1:27 Page 5 of 5 measurements but these require additional flow trans- Publisher’sNote Springer Nature remains neutral with regard to jurisdictional claims in published ducer devices for measurement. Banding to a predeter- maps and institutional affiliations. mined luminal reduction of approximately 75% appears to be safe, equally effective and reduces the need for add- Author details Department of Interventional Radiology, Beaumont Hospital, Dublin, Ireland. itional costly equipment in most cases (Shukla et al. 2016). Department of Radiology, Royal College of Surgeons in Ireland, Dublin, Successful percutaneous AVF banding depends on the 3 Ireland. Department of Interventional Radiology, Austin Hospital, Melbourne, exclusion of other confounding causes for DASS symp- Australia. Interventional Neuroradiology Service, Austin Hospital, Melbourne, Australia. School of Medicine, Faculty of Health, Deakin University, Geelong, toms, particularly arterial insufficiency as illustrated in the VIC, Australia. second case. Often, it can be difficult to confidently exclude distal arterial disease on non-invasive assessment because Received: 24 July 2018 Accepted: 16 October 2018 of the excess shunting and resultant poor distal perfusion prior to banding due to the small calibre of the distal pal- References mar vessels and difficulties with optimal contrast timing on Goel N, Miller GA, Jotwani MC et al (2006) Minimally invasive limited ligation Endoluminal-assisted revision (MILLER) for treatment of dialysis access- CT angiography. Therefore, upper limb digital subtraction associated steal syndrome. Kidney Int 70(4):765–770 angiography with treatment of underlying arterial stenoses Gupta N, Yuo TH, Gt K et al (2011) Treatment strategies of arterial steal after prior to banding is essential for clinical success if there is arteriovenous access. J Vasc Surg 54(1):162–167 Leake AE, Winger DG, Leers SA, Gupta N, Dillavou ED (2015) Management and clinical concern for associated arterial disease (Shukla et al. outcomes of dialysis access-associated steal syndrome. J Vasc Surg 61(3):754–760 2016). In particular, revascularisation strategies should aim Miller GA, Goel N, Friedman A et al (2010) The MILLER banding procedure is an to restore adequate inflow to the palmar arch and digits, effective method for treating dialysis-associated steal syndrome. Kidney Int 77(4):359–366 particularly where tissue loss is of concern. Shukla PA, Kolber MK, Nwoke F et al (2016) The MILLER banding procedure as a treatment alternative for dialysis access steal syndrome: a single institutional experience. Clin Imaging 40(3):569–572 Conclusion Vascular Access Work G (2006) Clinical practice guidelines for vascular access. Am Percutaneous AVF banding is an effective and safe J Kidney Dis 48(Suppl 1):S176–S247 minimally-invasive technique for treatment of ischaemic DASS with good intermediate-term patency rates, com- parable to more invasive surgical procedures. However, there is a need for further studies to assess long-term outcomes including late thrombosis rates. Abbreviations AVF: Arteriovenous fistula; AVG: Arteriovenous grafts; DASS: Dialysis-access steal syndrome; DRIL: Distal revascularisation and interval ligation; MILLER: Minimally Invasive Limited Ligation Endoluminal-assisted Revision; RUDI: Revision using distal inflow Acknowledgements Not applicable. Funding No funding was obtained for this project. Availability of data and materials Data sharing not applicable to this article as no datasets were generated or analysed during the current study. Authors’ contributions HKK participated and performed the procedure and drafted the manuscript; JM, HA edited and drafted the manuscript; ER, MS, MFG, MJL participated and performed the procedure and drafted and edited the manuscript. All authors read and approved the final manuscript. Ethics approval and consent to participate An ethics waiver has been provided and patient consent for the procedures was obtained. Consent for publication The patients consented to publication of their cases. Competing interests The authors declare that they have no competing interests.

Journal

CVIR Endovascular – Springer Journals

Published: Nov 3, 2018

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