Talk:Dialysis
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Proposed Addition for Wikipedia "Dialysis" Article (Vascular Access Section)
[edit]Proposed Addition for Wikipedia "Dialysis" Article (Vascular Access Section) Note for Talk Page: These paragraphs could be added to the "Vascular Access" or "Complications" section to highlight flow restriction techniques like the MILLER procedure, emphasizing its high patency rates in the context of overall dialysis access outcomes. All content is based on published studies for neutrality. Vascular access complications, such as dialysis access steal syndrome (DASS) and high-output heart failure (HOHF), are common in high-flow arteriovenous fistulas and grafts, affecting 10–20% of patients. Flow restriction procedures aim to normalize blood flow to physiologic levels, reducing shear stress and pulsatile pressure that contribute to venous stenosis and cardiac strain. The Minimally Invasive Limited Ligation Endoluminal-assisted Revision (MILLER) banding procedure, developed in 2006, is a notable example, using balloon-guided ligation to achieve precise flow reduction. Clinical studies of MILLER banding have reported high patency rates, particularly for revision of dysfunctional accesses. In a cohort of 183 patients, secondary access patency was 90% at 24 months, with primary band patency ranging from 66–83% at 12 months and low thrombotic event rates (0.1–0.9 per access-year).[1] Symptom resolution for DASS and HOHF was achieved in 90–100% of cases, making it one of the most effective salvage techniques. Compared to primary arteriovenous fistulas, MILLER banding's secondary patency rates (75–90% at 12–24 months) are competitive or superior when accounting for the 20–60% maturation failure rate of fistulas, which reduces their overall effective patency to approximately 50–75% and prolongs catheter dependence.[2][3] This underscores the potential of flow restriction to improve long-term outcomes in high-flow accesses without the initial risks of fistula maturation failure. stan batiste (talk) 20:37, 28 December 2025 (UTC)
References
- ↑ Miller, Gregg A.; Goel, Naveen; Friedman, Alexander; Khariton, Alexander; Jotwani, Manoj C.; Savransky, Yevgeny; Trerotola, Scott O.; Shatsky, Joshua B.; Trerotola, Scott O. (2010). "The MILLER banding procedure is an effective method for treating dialysis-associated steal syndrome". Kidney International. 77 (4): 359–366. doi:10.1038/ki.2009.461. PMID 19940840.
- ↑ Vascular Access Work Group (2006). "Clinical Practice Guidelines for Vascular Access". American Journal of Kidney Diseases. 48 (Suppl 1): S248–S273. doi:10.1053/j.ajkd.2006.04.029. PMID 16813991.
- ↑ Allon, Michael; Robbin, Michelle L.; Young, Carlton J.; Deierhoi, Mark H.; Goodman, Jean; Hanaway, Michael; Lockhart, Mark E.; Love, William (2007). "Preoperative venous intimal hyperplasia associated with postoperative arteriovenous fistula failure". American Journal of Kidney Diseases. 50 (5): 782–788. doi:10.1053/j.ajkd.2007.07.022. PMID 17954292.