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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

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Department of General Surgery, Mayo Clinic Arizona, Phoenix, AZ 85054, USA
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Division of Vascular Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, Phoenix, AZ 85054, USA
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Division of Vascular Surgery, Mayo Clinic Arizona, Phoenix, AZ 85054, USA
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Division of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2018, 7(6), 128; https://doi.org/10.3390/jcm7060128
Received: 29 April 2018 / Revised: 25 May 2018 / Accepted: 28 May 2018 / Published: 29 May 2018
(This article belongs to the Special Issue Image Guided Interventions and Emerging Technologies)
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. View Full-Text
Keywords: MILLER; dialysis associated steal syndrome; high flow; arteriovenous fistula; arteriovenous fistula banding MILLER; dialysis associated steal syndrome; high flow; arteriovenous fistula; arteriovenous fistula banding
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Sheaffer, W.W.; Hangge, P.T.; Chau, A.H.; Alzubaidi, S.J.; Knuttinen, M.-G.; Naidu, S.G.; Ganguli, S.; Oklu, R.; Davila, V.J. 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. J. Clin. Med. 2018, 7, 128.

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