ABSTRACT
OBJECTIVE: To describe a single institutional experience with minimally invasive limited ligation endoluminal-assisted revision (MILLER) for treatment of dialysis access steal syndrome (DASS). MATERIALS AND METHODS: Twenty patients were retrospectively identified that underwent 30 MILLER band procedures for DASS at our institution from March 2010 to December 2014. Technical success was defined by successful creation of MILLER band with preservation of flow for hemodialysis. Clinical success was defined as complete resolution of signs and symptoms with preservation of dialysis access in a 1-month postprocedural period. Primary MILLER band patency, postintervention-assisted primary access patency, and postprocedure secondary access patency are reported. RESULTS: Technical success was achieved in all patients. Clinical success was achieved in 75% of patients after one banding procedure and in 95% of patients after two banding procedures. One patient experienced access thrombosis following the initial banding procedure which was subsequently treated and did not lead to loss of access. MILLER band patency was 83% at 1 month and 77% at 6 months. Postintervention-assisted primary patency was 95%, 93%, and 92% at 3 months, 6 months, and 1 year, respectively. Postintervention secondary patency was 86%, 68%, and 59% at 3 months, 6 months, and 1 year, respectively. CONCLUSIONS: MILLER banding offers a less-invasive alternative to surgical therapy that appears to be safe and permits preservation of dialysis access.
Subject(s)
Arteriovenous Shunt, Surgical , Minimally Invasive Surgical Procedures/methods , Postoperative Complications/surgery , Renal Dialysis , Subclavian Artery/surgery , Subclavian Steal Syndrome/surgery , Adult , Aged , Female , Follow-Up Studies , Humans , Ligation/instrumentation , Ligation/methods , Male , Middle Aged , Minimally Invasive Surgical Procedures/instrumentation , Postoperative Complications/diagnostic imaging , Reoperation , Retrospective Studies , Subclavian Artery/diagnostic imaging , Subclavian Steal Syndrome/diagnostic imaging , Subclavian Steal Syndrome/etiology , Treatment OutcomeABSTRACT
The inferior epigastric artery represents a potentially overlooked source of pelvic arterial hemorrhage. The authors describe 3 patients with massive inferior epigastric artery bleeding following cesarean section, paracentesis, and blunt trauma that were successfully treated with transarterial embolization. The inferior epigastric artery should be considered as a possible source of arterial hemorrhage if arteriography of internal iliac artery branches does not yield a bleeding source.
