Stepwise Incision-Free Lumen-Calibrated Ligation: Initial Experience for Flow Modulation in Hemodialysis Arteriovenous Access

초록

To evaluate the clinical feasibility and safety of stepwise incision-free lumen-calibrated ligation (SILL) technique for controlling high-flow arteriovenous access and steal syndrome, this retrospective study included 13 consecutive patients (age: 57.5 years [standard deviation {SD} ± 16.6]; men: 53.8%) treated between January 2024 and March 2026. The procedure used needle-assisted suture banding with balloon-based lumen calibration and stepwise tightening when needed. Technical success was achieved in all the patients. Mean Qa decreased from 2,516 mL/min (SD ± 1,118) to 921 mL/min (SD ± 227), and venous diameter decreased from 8.20 mm (SD ± 2.23) to 4.28 mm (SD ± 0.70; both P < .001). Clinical success was achieved in 11 of 13 patients (84.6%). All patients treated for high-flow access maintained target flow at 1 month, and 4 of 6 patients with steal syndrome achieved complete symptom relief. No complications occurred. SILL enables incision-free, lumen-calibrated flow reduction with predictable hemodynamic control and favorable clinical outcomes. © 2026 SIR

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