Abstract
Objective
To describe a single institutional experience with minimally invasive limited ligation
endoluminal-assisted revision (MILLER) for treatment of dialysis access steal syndrome
(DASS).
Materials and Methods
Twenty patients were retrospectively identified that underwent 30 MILLER band procedures
for DASS at our institution from March 2010 to December 2014. Technical success was
defined by successful creation of MILLER band with preservation of flow for hemodialysis.
Clinical success was defined as complete resolution of signs and symptoms with preservation of dialysis
access in a 1-month postprocedural period. Primary MILLER band patency, postintervention-assisted
primary access patency, and postprocedure secondary access patency are reported.
Results
Technical success was achieved in all patients. Clinical success was achieved in 75%
of patients after one banding procedure and in 95% of patients after two banding procedures.
One patient experienced access thrombosis following the initial banding procedure
which was subsequently treated and did not lead to loss of access. MILLER band patency
was 83% at 1 month and 77% at 6 months. Postintervention-assisted primary patency
was 95%, 93%, and 92% at 3 months, 6 months, and 1 year, respectively. Postintervention
secondary patency was 86%, 68%, and 59% at 3 months, 6 months, and 1 year, respectively.
Conclusions
MILLER banding offers a less-invasive alternative to surgical therapy that appears
to be safe and permits preservation of dialysis access.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical ImagingAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Understanding the dialysis access steal syndrome. A review of the etiologies, diagnosis, prevention and treatment strategies.J Vasc Access. 2008; 9: 155-166
- Ischemic steal syndrome: a case series and review of current management.Curr Surg. 2006; 63: 130-135
- Treatment strategies of arterial steal after arteriovenous access.J Vasc Surg. 2011; 54: 162-167
- Hand ischemia associated with dialysis vascular access: an individualized access flow-based approach to therapy.Semin Dial. 2013; 26: 287-314
- Flow interruption of the distal radial artery: treatment for finger ischemia in a matured radiocephalic AVF.J Vasc Access. 2008; 9: 58-63
- Coil embolization as a treatment alternative for dialysis-associated steal syndrome.Vasc Endovascular Surg. 2012; 46: 546-549
- Minimally Invasive Limited Ligation Endoluminal-assisted Revision (MILLER) for treatment of dialysis access-associated steal syndrome.Kidney Int. 2006; 70: 765-770
- The MILLER banding procedure is an effective method for treating dialysis-associated steal syndrome.Kidney Int. 2010; 77: 359-366
- Hemodialysis arteriovenous fistula patency revisited: results of a prospective, multicenter initiative.Clin J Am Soc Nephrol. 2008; 3: 714-719
- Reporting standards for percutaneous interventions in dialysis access.J Vasc Interv Radiol. 2003; 14: S433-S442
- Experimental study of hemodynamics in procedures to treat access-related ischemia.J Vasc Surg. 2008; 48: 1559-1565
- High-output cardiac failure due to excessive shunting in a hemodialysis access fistula: an easily overlooked diagnosis.Am J Nephrol. 1995; 15: 323-326
- High-output heart failure secondary to arteriovenous fistula.Hemodial Int. 2011;
- Steal syndrome--strategies to preserve vascular access and extremity.Nephrol Dial Transplant. 2008; 23: 19-24
- Management and outcomes of dialysis access-associated steal syndrome.J Vasc Surg. 2015; 61: 754-760
- Prediction of graft patency and mortality after distal revascularization and interval ligation for hemodialysis access-related hand ischemia.J Vasc Surg. 2013; 57: 451-458
Article info
Publication history
Published online: October 02, 2015
Accepted:
September 29,
2015
Received in revised form:
September 17,
2015
Received:
June 24,
2015
Footnotes
☆Financial Disclosures: None.
☆☆Conflicts of Interest: None.
Identification
Copyright
© 2015 Elsevier Inc. All rights reserved.
