Is polytetrafluoroethylene circular banding an effective technique for treatment of high-flow vascular access-induced steal syndrome?

Objective
The aim was to evaluate the efficacy and safety of polytetrafluoroethylene (PTFE) banding for treatment of high-flow vascular access-induced steal syndrome.
Patients and methods
The prospective study was conducted at Vascular Surgery Departments, Zagazig University Hospitals, Egypt and Alnoor Specialist Hospital, Makkah, Saudi Arabia from February 2016 to October 2019. The study included 19 cases (11 women). The mean age was 54 years. The access was brachiocephalic; arteriovenous fistula (AVF) in 11 patients, transposed brachiobasilic AVF in three patients and upper-arm synthetic in five patients. The mean duration of access was 1.2 years. Stages of steal were (stage II: three cases, stage III: nine cases, stage IV: seven cases).
Results
There was complete relief in 15 (79%) patients, while only partial improvement in four (21%) patients; one patient achieved complete relief with another banding, one patient continued to use his access with partial (but tolerable) symptomatic relief, one patient required distal revascularization and interval ligation, and the remaining patients underwent ligation. The average initial flow in native AVF was 2074 ml/min and in synthetic access was 2437 ml/min, and the average flow reduction after banding was 1025 ml/min (49%) in AVF and was 1247 ml/min (51%) in synthetic access. Only minor complications occurred in the form of cellulitis in two cases and mild bleeding in one case. Banding-related thrombectomy was done in three (16%) patients. Follow-up was for 1 year. Primary patency was 74 and 63% at 6 and 12 months, respectively, and secondary patency was 84 and 74% at 6 and 12 months, respectively.
Conclusion
PTFE banding is a simple technique to preserve the access function and treat symptoms of steal caused by high flow access. It is less time consuming, with lesser complications and accepted success rate and can be done as a day case procedure when compared with bypass techniques. So, PTFE banding can be used as an initial successful procedure for treating steal associated with high-flow access.