One strategy to relieve cardiac overload or dialysis assess-induced steal syndrome is to band an AV fistula in order to increase flow resistance. By reducing AV fistula flow, flow increases in distal extremities. Of course, maintaining a functional AV access with sufficient flow to deliver hemodialysis is paramount throughout the salvage procedure. Two banding techniques use Transonic® intraoperative flow measurement to guide the banding procedure.
Dr. M.R. Scheltinga of Máxima Medical Center, Veldhoven, the Netherlands, pioneered continuous intraoperative flow measurements during fistula banding to achieve a pre-set flow goal. He begins with a pre-operative AV fistula flow level and sets a percent decrease in AV fistula flow to be achieved by banding. As the band is tightened, AV fistula venous outflow is measured by a Flowprobe and Transonic Flowmeter.
Dr. J.U. Zamora II from the Balboa Institute in San Diego uses an Artegraft® collagen bovine graft guided by Transonic Flowprobe measurements to band a high flow AVF. The Flowprobes can be placed directly on the Artegraft bovine graft for direct flow measurement since Artegraft is a biomaterial. Unlike all PTFE grafts, Artegraft has no air in the graft wall that will attenuate ultrasound. As such, Artegraft (and fistula) flow can be continuously measured at the venous end of the dissection with the Flowprobe.
Also see: MILLER Banding with Intragraft flow measurements with the ReoCath® Flow Catheter
Dr. Gregg A. Miller, an interventional nephrologist with American Access Care, Brooklyn, NY, treats dialysis associated steal syndrome or high-flow access problems with his Minimally Invasive Limited Ligation Endoluminal-Assisted Revision (MILLER) banding procedure. He uses the Endovascular HVT100 Flowmeter and ReoCath® Flow Catheter for pre-and post-measurements of flow that guide and document his procedure.