Advertisement

Dilator-assisted banding and beyond: proposing an algorithm for managing dialysis access-associated steal syndrome

Dilator-assisted banding and beyond: proposing an algorithm for managing dialysis access-associated steal syndrome

J Vasc Access 2016; 17(4): 299 - 306

Article Type: ORIGINAL ARTICLE

DOI:10.5301/jva.5000570

Authors

Shouwen Wang, Arif Asif, William C. Jennings

Abstract

Dialysis access-associated steal syndrome (DASS) is a major complication of arteriovenous hemodialysis accesses. Although its underlying pathology is diverse, it is most often associated with excessive access flow. Dilator-assisted banding (DAB) is a simple flow-reduction technique that we described previously. This report is to illustrate the expansion of DAB and analyze the outcome of DAB in managing DASS.

From February 2011 to April 2015, 30 patients underwent DAB for DASS. Their relevant clinical data were retrospectively reviewed or prospectively collected, and further analyzed statistically.

Of the 30 patients, 23 had an arteriogram and 3 required angioplasty ± stent placement for inflow artery stenosis. Besides intraluminal DAB (12/30), this report also included extraluminal DAB (14/30) and open fistula reduction plus DAB (4/30). After DAB, the severity scores of DASS were reduced from 2.8 ± 0.4 to 0.2 ± 0.4 for the fistula group (n = 24, p<0.001) and from 3.0 ± 0.0 to 1.2 ± 1.2 for the graft group (n = 6, p = 0.041). DAB was effective in all but two graft patients who subsequently underwent proximalization of arterial inflow (PAI) that resulted in resolution of DASS. During follow-up of 18.7 ± 14.5 months (range 1-50), all accesses remained functional. At 24-months post-DAB, the primary patency, primary-assisted patency and secondary patency rates of the fistula group were 72%, 91% and 100%, respectively.

DAB is a simple, effective and versatile approach for managing DASS. PAI may be employed for rescue or as primary choice when banding is ineffective. Based on our data and the literature, an algorithm is proposed for managing DASS.

Article History

Disclosures

Financial support: No grants or funding have been received for this study.
Conflict of interest: None of the authors has financial interest related to this study to disclose.

This article is available as full text PDF.

  • If you are a Subscriber, please log in now.

  • Article price: Eur 36,00
  • You will be granted access to the article for 72 hours and you will be able to download any format (PDF or ePUB). The article will be available in your login area under "My PayPerView". You will need to register a new account (unless you already own an account with this journal), and you will be guided through our online shop. Online purchases are paid by Credit Card through PayPal.
  • If you are not a Subscriber you may:
  • Subscribe to this journal
  • Unlimited access to all our archives, 24 hour a day, every day of the week.

Authors

  • Wang, Shouwen [PubMed] [Google Scholar] 1, * Corresponding Author (swang@akdhc.com)
  • Asif, Arif [PubMed] [Google Scholar] 2
  • Jennings, William C. [PubMed] [Google Scholar] 3

Affiliations

  • AKDHC Access Centers, Arizona Kidney Disease and Hypertension Center, Phoenix, Arizona - USA
  • Division of Nephrology and Hypertension, Albany Medical College, Albany, New York - USA
  • Department of Surgery, University of Oklahoma-Tulsa, Tulsa, Oklahoma - USA

Article usage statistics

The blue line displays unique views in the time frame indicated.
The yellow line displays unique downloads.
Views and downloads are counted only once per session.

No supplementary material is available for this article.