Pledgeted plication: A novel technique to treat dialysis access-related steal syndrome

Abstract

Steal syndrome is a potential complication of surgically created arteriovenous fistulas that can result in sensory and/or motor deficits, or tissue loss in the affected limb. Several surgical techniques have been developed to treat steal syndrome, but all have potential drawbacks. We detail a novel, modified plication technique which involves sequential, longitudinal application of pledgets along the venous outflow to gradually narrow it, and consequently decrease flow. Its potential benefits include protection of the vein from bare suture, less turbulent flow, and thus lower risk of thrombosis. Implementation of this technique in two patients resulted in symptomatic relief and continuation of uninterrupted hemodialysis at 9- and 12-month follow-up, respectively.

Long term outcomes of ‘Christmas Tree’ banding for haemodialysis access induced distal ischemia: A 13-year experience

“…Although most patients remain asymptomatic by adjusting via collateralization and compensatory flow mechanisms, a subset of patients who are unable to adequately compensate, develop manifestations of ischemia, necessitating surgical intervention. These interventions include fistula banding, plication 11,12 revascularization using distal inflow (RUDI), 13 distal revascularization with interval ligation (DRIL), 14 the Minimally Invasive Limited Ligation Endoluminal-assisted Revision (MILLER) procedure, 15 proximalisation of arterial inflow (PAI) 16,17 or ligation of larger side branches to reduce the extent of distal ischemia. 18 While these procedures can potentially reverse ischemia associated with steal allowing preservation of access for HD, patients with insufficient relief of symptoms after access revision may need ligation or sacrifice of access.…”