Minimally Invasive Limited Ligation Endoluminal-assisted Revision (MILLER) for treatment of dialysis access-associated steal syndrome

N. Goel, G. A. Miller, M. C. Jotwani, J. Licht, I. Schur, W. P. Arnold

Research output: Contribution to journalArticle

Abstract

Dialysis-associated steal syndrome (DASS) is defined as a clinical condition caused by arterial insufficiency distal to the dialysis access owing to diversion of blood into the fistula or graft. The incidence of symptomatic DASS requiring treatment is 1-8%. The etiology is iatrogenic and symptoms are quite debilitating. Banding of the access inflow has largely been abandoned because of the inherent problem with balancing fistula flow with distal flow complicated by a high incidence of subsequent access thrombosis. In this study, we are reporting a modification to the traditional banding procedure, which markedly improves banding outcomes. We are reporting 16 patients who underwent a new standardized minimally invasive banding procedure performed in an outpatient setting with minimal morbidity. This modified banding procedure requires a small (1-2 cm) skin incision for the placement of a ligature and utilizes a 4 or 5 mm diameter endoluminal balloon to achieve and standardize the desired reduction of inflow size. All 16 patients had immediate symptomatic and angiographic improvement after the procedure. Follow-up showed none of the patients had recurrence of symptoms or thrombosis of the access. In our experience, this procedure is an excellent treatment option because of its simplicity and should be considered as a first-line treatment for patients with DASS.

Original languageEnglish (US)
Pages (from-to)765-770
Number of pages6
JournalKidney International
Volume70
Issue number4
DOIs
StatePublished - Aug 28 2006
Externally publishedYes

Fingerprint

Ligation
Dialysis
Fistula
Thrombosis
Therapeutics
Incidence
Outpatients
Morbidity
Transplants
Recurrence
Skin

Keywords

  • Arteriovenous access
  • DASS
  • DRIL
  • IMN
  • Steal syndrome

ASJC Scopus subject areas

  • Nephrology

Cite this

Minimally Invasive Limited Ligation Endoluminal-assisted Revision (MILLER) for treatment of dialysis access-associated steal syndrome. / Goel, N.; Miller, G. A.; Jotwani, M. C.; Licht, J.; Schur, I.; Arnold, W. P.

In: Kidney International, Vol. 70, No. 4, 28.08.2006, p. 765-770.

Research output: Contribution to journalArticle

Goel, N. ; Miller, G. A. ; Jotwani, M. C. ; Licht, J. ; Schur, I. ; Arnold, W. P. / Minimally Invasive Limited Ligation Endoluminal-assisted Revision (MILLER) for treatment of dialysis access-associated steal syndrome. In: Kidney International. 2006 ; Vol. 70, No. 4. pp. 765-770.
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