Dilator‐Assisted Banding for Managing Complications Associated with Excessive Hemodialysis Access Flow

Excessive hemodialysis access flow can be associated with serious complications, such as ischemic steal syndrome and heart failure. Among the therapeutic approaches, endoluminal balloon-guided banding has the advantage of being minimally invasive. However, it requires fluoroscopic guidance. We here report a simpler approach, Dilator-assisted Banding (DAB), in which over-the-wire vascular dilators of known diameters are used as endoluminal-guides to achieve precision banding with or without fluoroscopic guidance. The dilators used are 10, 12, and 14 French, corresponding to 3.3, 4.0, and 4.7 mm in diameter, respectively. Of the seven treated patients with ischemic steal syndrome, three were males, mean age was 67.7 ± 16.3 years, five were diabetics, all were hypertensive, five had fistulas, and two had grafts. Mean age of hemodialysis accesses was 17.2 ± 8.4 months. Three patients had banding without fluoroscopic guidance, including two performed during fistula vein superficialization and basilic vein transposition. With follow-up of 2-12 months, all hemodialysis accesses remained functional. Six patients had complete resolution and one reported marked improvement of ischemic symptoms. In summary, DAB is a simple, effective, and economical flow-reduction alternative for managing ischemic steal syndrome and potentially other complications associated with excessive access flows. In addition, it can be safely performed without fluoroscopic guidance.