Modified Banding of Arteriovenous Fistulas for the Treatment of Vascular Access Induced Digital Ischaemia

Objective: Vascular access induced digital ischaemia is an uncommon complication of haemodialysis access procedures and is difficult to manage. Several techniques have been described to treat this phenomenon, with variable long term success. Although all of these procedures have been shown to work, they have a significant failure rate, such as persistent high vascular access flow or loss of access. One of the major technical limitations of these techniques is the lack of quantitative data gathered during the procedure to ensure treatment success. In this study, the aim was to describe a novel technique that can improve the success of banding in preserving access and eliminating digital ischaemia. Technique: A modified method for arteriovenous fistula banding that incorporates measurements of distal arterial pressure to improve the success of the procedure is described. Results: Sixteen patients with vascular access induced digital ischaemia and high-flow vascular access were treated using the technique. All procedures were technically successful. At 30 days, complete symptomatic relief (clinical success) was seen in 81% (n = 13) of patients. There was no access thrombosis or infection in any of the patients at the 30 day follow up. Six month follow up data were available in seven patients. There was no loss of access patency or recurrence of symptoms observed at six months. Conclusion: This novel technique is simple and effective and can be used safely as first line therapy for the management of vascular access induced digital ischaemia.