O076 Long term outcomes of "Christmas tree" banding for the treatment of dialysis access related steal syndrome: a thirteen-year experience with the technique. (22nd July 2022)

• Record Type: Journal Article
• Authors: Ravindhran, B; Totty, JP; Carradice, D; Chetter, IC; Smith, GE
• Is Part Of: British journal of surgery. Volume 109(2022)Supplement 4
• Publication Date: 2022-07-22
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1093/bjs/znac242.076
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: Introduction: High flowrates in arterio-venous fistulas (AVF) and the associated distal arterial insufficiency can cause Dialysis-Access related Steal Syndrome (DASS). Various techniques including ligation, banding, and bypass with interval-ligation have been advocated to treat this difficult problem with varying success. We present the long-term outcomes following a novel banding technique. Methods: 46 patients in this prospective cohort-study from 2008–2021 underwent an adjustable banding procedure using a PTFE patch shaped with one slit-end and saw-tooth edges (resulting in a ''Christmas tree'' pattern) to provide a ratchet mechanism to progressively constrict the draining vein. Real-time finger perfusion pressure monitoring allowed an optimal compromise between distal extremity and AVF perfusion. Comparisons between groups were measured and survival curves were obtained using the Kaplan-Meier method based on the log-rank test to calculate the thrombosis-free survival. Results: 63%(n=29) presented with constant pain and 24%(n=11) presented with tissue loss due to steal syndrome. Post-intervention patency was 100%, 97.7%, 95%, 86% and 72% at 30 days, 60 days, 180 days, 1 year and 3 years, respectively. Complete resolution of symptoms was achieved in 74%(n=34) of patients and 11%(n=5) reported partial response needing no further intervention. We also observed that pre-procedure finger pressures of 41mmHg or below was highly specific for "true" steal-syndrome and these patients were more likely to completely respond to banding (p=0.016). The overall mean thrombosis free survival was seen to be 1844±168 days. Conclusion: This adjustable dynamic method of AVF banding demonstrates a sustained efficacy in patients with DASS in the long term with a very low risk of patency loss. Take-home message: The described adjustable dynamic method of AVF banding under local anaesthesia demonstrates a sustained efficacy in patients with DASS in the long term with a very low risk of patency loss.