A “Christmas Tree” Band for the Treatment of Arteriovenous Dialysis Access–Related Steal Syndrome

Abstract

Dialysis access steal syndrome (DASS) is an uncommon but often debilitating complication of dialysis access formation. We present a technical description of a novel arteriovenous fistula (AVF) banding technique for the treatment of DASS and the results of a short case series. A polyethylene terephthalate carotid patch is shaped with a slit at 1 end and saw tooth edges (resulting in a "Christmas tree" shape) so as to provide a ratchet mechanism to progressively constrict the draining vein of the AVF. This is performed with finger perfusion pressure measures to allow optimal compromise between distal extremity and AVF perfusion. Data on 6 patients with brachiocephalic AVF treated with this technique are included in a case series. During the follow-up of mean of 14 months (range, 2-36 months), all AVFs remained patent and in active use for dialysis. No alternative access was required in the immediate post- or perioperative period. All patients had relief of rest pain or evidence of healing at the last follow-up. Christmas tree banding with finger pressure measurements can offer successful treatment for DASS.