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논문분류	춘계학술대회 초록집
제목	A Case of Successful Dilator-Assiseted Banding Procedure Instead of MILLER Procedure for the Treatment of Dialysis Access-Associated Steal Syndrome
저자	Jin Ho Lee
출판정보	2025; 2025(1):
키워드	Vascular access, DASS, dilator-assisted bandig
초록	Vascular access(VA) is the lifeline of hemodialysis patients. When vascular access is created, various complications can occur. Dialysis access-associated steal syndrome(DASS) is one of the common complications, is mostly asymptomatic, but may cause pain, coldness, and delayed healing. When DASS occurs, treatment is to reduce the diameter of the VA to increase distal flow. 75-year-old male patient underwent Rt. brachiocephalic fistula surgery in 2023. The patient complained of a cold sensation in his right hand and severe stabbing pain, and the wounds on the tips of his second and third fingers had not healed for three months. In VA ultrasound, the blood flow of the brachial artery increased from 1200 to 2400 ml/min, and the diameter of the VA was 12mm. The diameters of the radial artery was 1 mm, and blood flow was observed in the distal to proximal direction. We decided to perform MILLER banidng procedure. A 5*40mm balloon was placed at the juxta-anastomosis site, the skin was incised, and the VA was dissected. Afterwards, a tie was made with 2.0 silk according to the balloon size, but the distal flow was not sufficiently improved. Afterwards, we decided to perform dilator-assisted banding, and the dilator(outer diameter 2.7mm) used for TCC insertion was placed on the VA, and ties were performed twice using 2.0 silk. Then, dilator was removed. Angiography showed normal flow in the radial artery and blood flow in the palmar arch. After 7 days of the procedure, the pain decreased from NRS 8 to 2, and the wound was almost completely healed. When DASS occurs, banding to reduce blood flow to the vascular access is the first treatment. For this purpose, not only MILLER banding or surgical banding, but also dilator-assisted banding can be used safely and effectively.
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