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The MILLER banding procedure as a treatment alternative for dialysis access steal syndrome: a single institutional experience

  • Pratik A. Shukla
    Affiliations
    Division of Vascular and Interventional Radiology, Department of Radiology, Mount Sinai Beth Israel, First Avenue at 16th Street, New York, NY 10003
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  • Marcin K. Kolber
    Affiliations
    Division of Vascular and Interventional Radiology, Department of Radiology, Mount Sinai Beth Israel, First Avenue at 16th Street, New York, NY 10003
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  • Franklin Nwoke
    Affiliations
    Division of Vascular and Interventional Radiology, Department of Radiology, Mount Sinai Beth Israel, First Avenue at 16th Street, New York, NY 10003
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  • Abhishek Kumar
    Affiliations
    Division of Vascular and Interventional Radiology, Department of Radiology, Mount Sinai Beth Israel, First Avenue at 16th Street, New York, NY 10003
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  • Joseph N. Shams
    Affiliations
    Division of Vascular and Interventional Radiology, Department of Radiology, Mount Sinai Beth Israel, First Avenue at 16th Street, New York, NY 10003
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  • James E. Silberzweig
    Correspondence
    Corresponding author. Department of Radiology, Mount Sinai Beth Israel, First Avenue at 16th Street, New York, NY 10003. Tel.: +1-212-420-2409; fax: +1-212-420-2073.
    Affiliations
    Division of Vascular and Interventional Radiology, Department of Radiology, Mount Sinai Beth Israel, First Avenue at 16th Street, New York, NY 10003
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      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

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