| Autor: |
Sheaffer WW; Department of General Surgery, Mayo Clinic Arizona, Phoenix, AZ 85054, USA. sheaffer.william@mayo.edu., Hangge PT; Department of General Surgery, Mayo Clinic Arizona, Phoenix, AZ 85054, USA. hangge.patrick@mayo.edu.; Division of Vascular Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, Phoenix, AZ 85054, USA. hangge.patrick@mayo.edu., Chau AH; Division of Vascular Surgery, Mayo Clinic Arizona, Phoenix, AZ 85054, USA. chau.anthony@mayo.edu., Alzubaidi SJ; Division of Vascular Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, Phoenix, AZ 85054, USA. alzubaidi.sadeer@mayo.edu., Knuttinen MG; Division of Vascular Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, Phoenix, AZ 85054, USA. knuttinen.grace@mayo.edu., Naidu SG; Division of Vascular Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, Phoenix, AZ 85054, USA. naidu.sailen@mayo.edu., Ganguli S; Division of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. sganguli@partners.org., Oklu R; Division of Vascular Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, Phoenix, AZ 85054, USA. oklu.rahmi@mayo.edu., Davila VJ; Division of Vascular Surgery, Mayo Clinic Arizona, Phoenix, AZ 85054, USA. davila.victor@mayo.edu. |
| Abstrakt: |
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. |
