Minimally Invasive Limited Ligation Endoluminal-Assisted Revision (MILLER): A Review of the Available Literature and Brief Overview of Alternate Therapies in Dialysis Associated Steal Syndrome.

William Sheaffer,Anthony Chau,Patrick Hangge,Victor Davila,M-Grace Knuttinen,Sadeer Alzubaidi,Sailendra Naidu,Suvranu Ganguli,Rahmi Oklu

doi:10.3390/jcm7060128

Abstract

Dialysis associated steal syndrome (DASS) is a relatively rare but debilitating complication of arteriovenous fistulas. While mild symptoms can be observed, if severe symptoms are left untreated, DASS can result in ulcerations and limb threatening ischemia. High-flow with resultant heart failure is another documented complication following dialysis access procedures. Historically, open surgical procedures have been the mainstay of therapy for both DASS as well as high-flow. These procedures included ligation, open surgical banding, distal revascularization-interval ligation, revascularization using distal inflow, and proximal invasion of arterial inflow. While effective, open surgical procedures and general anesthesia are preferably avoided in this high-risk population. Minimally invasive limited ligation endoluminal-assisted revision (MILLER) offers both a precise as well as a minimally invasive approach to treating both dialysis associated steal syndrome as well as high-flow with resultant heart failure. MILLER is not ideal for all DASS patients, particularly those with low-flow fistulas. We aim to briefly describe the open surgical therapies as well as review both the technical aspects of the MILLER procedure and the available literature.

Highlights

In 2015, 30 million American adults were known to have chronic kidney disease with approximately 124,000 new cases of end stage renal disease reported [1]
The minimally invasive limited ligation endoluminal-assisted revision, or Minimally invasive limited ligation endoluminal-assisted revision (MILLER), procedure offerTshaesmtainndimaradlilzyeidnvmaestihvoedlitmoittreaddliitgioantiaolnbaennddionlgumprinocael-daussreisstefodrrterveiastiionng,DorAMSSIL(FLiEgRur, ep4ro).cedure offers a standardized method to traditional banding procedures for treating dialysis access steal syndrome (DASS) (Figure 4)
Clin.TMheed. m20i1n8,im7, 1a2l8ly invasive limited ligation endoluminal-assisted revision, or MILLER, proce6douf 1r0e offers a standardized method to traditional banding procedures for treating DASS (Figure 4)

Summary

Introduction

In 2015, 30 million American adults were known to have chronic kidney disease with approximately 124,000 new cases of end stage renal disease reported [1]. In the absence of transplant, treatment options for end stage renal disease rely heavily on hemodialysis. The Fistula First Initiative was developed to encourage preferential use of arteriovenous fistulas compared to catheters and synthetic grafts as it provides the best long-term patency rates, improves quality of life, and is associated with the lowest mortality rates. Both autologous AV fistulas and synthetic grafts can have complications, including dialysis access steal syndrome (DASS) and high flow with resultant heart failure [2,3,4]

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Conclusion