Modified Miller banding technique for ischemia in native fistulae

Abstract

Treating upper limb ischemia or dialysis access-associated steal syndrome (DASS) is controversial. Many treatments have been described for this pathology; one of the techniques of preference in our institution is banding with the technique described by Miller et al. of minimally invasive endoluminal-assisted limited ligation revision (MILLER), in which we have modified to avoid the intercurrences it causes. Four cases of stage II steal are presented in which the Miller technique is performed in which, instead of banding with a 2-0 Prolene suture, it is surrounded with a 1 cm wide PTFE segment. An angioplasty balloon is used to calibrate the desired diameter of the banding, and a Doppler ultrasound is performed to evaluate the flow before and after the procedure, as in the Miller technique. The procedure allowed ischemia to be resolved, and the fistulas were found to be permeable without evidence of the complications usually described.