ORIGINAL ARTICLE   

Italian Journal of Vascular and Endovascular Surgery 2021 June;28(2):56-8

DOI: 10.23736/S1824-4777.21.01440-6

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

A modified banding technique: experience of a center

Sofia S. CERQUEIRA ¹ ✉, Joana M. FERREIRA ², Mónica R. FRUTUOSO ¹, Catarina EUSEBIO ¹, Rui A. CASTRO ¹, Teresa M. MORGADO ¹

¹ Department of Nephrology, Hospital of Vila Real, Trás-os-Montes e Alto Douro Hospitals, Vila Real, Portugal; ² Department of Vascular Surgery, Hospital of Senhora da Oliveira, Creixomil, Guimarães, Portugal

BACKGROUND: A well-functioning vascular access is vital to patients on regular hemodialysis. Hence, high-flux dialysis accesses are a great cause of comorbidity in patients performing regular hemodialysis. The Vascular Access Society has defined a high-flow access as one with a flow between 1-1.5 L/min or a Qa that is >20% of the cardiac output. Clinical presentation varies, because there is no direct correlation between access flow and clinical manifestations. Patients with high-flux dialysis accesses can present with acute decompensation of chronic heart failure, pulmonary hypertension, central vein stenosis or symptoms of low hand perfusion. In severe cases, hemodialysis access-induced distal ischemia (HAIDI, otherwise known as “steal syndrome”) can develop. Banding the access is indicated in high flow associated steal syndrome. It allows for the reduction of access flow while maintaining distal limb perfusion. Main complications of the banding surgery are hemorrhage, infection, aneurysm formation, thrombosis of access in cases of overbanding, or otherwise insufficient reduction of vascular flow.
METHODS: We performed a modified banding technique in six patients without endovascular placement of the angioplasty balloon, which is a viable alternative to other techniques.
RESULTS: We verified that this technique allowed for access flow reduction in all our six patients, with total resolution of symptoms. No major complications were noted during our follow-up.
CONCLUSIONS: This technique allows for correction of high-flow arteriovenous fistulas in an efficient and safe way, and can be a viable alternative to other banding procedures.

KEY WORDS: Renal dialysis; Hemodynamics; Ischemia; Compression bandages