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J Clin Med. 2018 May 29;7(6). pii: E128. doi: 10.3390/jcm7060128.

Minimally Invasive Limited Ligation Endoluminal-Assisted Revision (MILLER): A Review of the Available Literature and Brief Overview of Alternate Therapies in Dialysis Associated Steal Syndrome.

Author information

1
Department of General Surgery, Mayo Clinic Arizona, Phoenix, AZ 85054, USA. sheaffer.william@mayo.edu.
2
Department of General Surgery, Mayo Clinic Arizona, Phoenix, AZ 85054, USA. hangge.patrick@mayo.edu.
3
Division of Vascular Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, Phoenix, AZ 85054, USA. hangge.patrick@mayo.edu.
4
Division of Vascular Surgery, Mayo Clinic Arizona, Phoenix, AZ 85054, USA. chau.anthony@mayo.edu.
5
Division of Vascular Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, Phoenix, AZ 85054, USA. alzubaidi.sadeer@mayo.edu.
6
Division of Vascular Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, Phoenix, AZ 85054, USA. knuttinen.grace@mayo.edu.
7
Division of Vascular Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, Phoenix, AZ 85054, USA. naidu.sailen@mayo.edu.
8
Division of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. sganguli@partners.org.
9
Division of Vascular Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, Phoenix, AZ 85054, USA. oklu.rahmi@mayo.edu.
10
Division of Vascular Surgery, Mayo Clinic Arizona, Phoenix, AZ 85054, USA. davila.victor@mayo.edu.

Abstract

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.

KEYWORDS:

MILLER; arteriovenous fistula; arteriovenous fistula banding; dialysis associated steal syndrome; high flow

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