MILLER Procedure for Steal Syndrome

Some individuals who have a fistula or a graft may develop a condition known as steal syndrome. This occurs when there is not enough blood flow to the hand in the access arm caused by the diversion of arterial blood from the hand to the access. Blood flow is pushed or diverted from high pressure arteries to low pressure veins, which results in a decrease in the arterial blood flow to the hand. When you have steal syndrome you may feel pain, coldness, numbness, or tingling in your hand. Your hand may also become pale in color. If you experience any of these symptoms, it is important to speak to your physician immediately. There are minimally invasive procedures that can be used to treat steal syndrome.

What is the MILLER Procedure?

Minimally Invasive Limited Ligation Endoluminal-assisted Revision, known as The MILLER procedure, is a technique used to balance blood flow through a dialysis access so that there is adequate circulation to the hand. This is accomplished by adjusting the access to the proper size to restore adequate blood flow to the hand. Using an angioplasty balloon as a sizing dowel, and then banding the access to the measured size.

Recovering from the MILLER Procedure

This procedure is minimally invasive and typically does not require an overnight stay, allowing you to go home shortly after the procedure is completed. Your physician may prescribe some pain medication to help with any discomfort, but you should be able to return to daily activities within 24 hours.

Benefits of the MILLER Procedure

Treating steal syndrome with the MILLER procedure offers many benefits compared with other techniques, including, the use of the balloon as a guide for band sizing which helps greatly with precision, it is the least invasive option, it is performed quickly in an outpatient setting, and is easily reversed or adjustable if needed.

As with any procedure where the skin is penetrated there is a slight risk of infection, be sure to speak with your physician to learn all the benefits and risks.

This procedure was developed and first described by Dr. Gregg Miller in 2006.  Dr. Miller, one of Azura Vascular Care’s pioneering physicians in the field of dialysis vascular access care.  Dr. Miller has published numerous papers related to advancing the use of evidence based care in this field.

How We Can Help You

The physicians at Azura are specialists in the field of dialysis access management. Our interventional radiologists, nephrologists, and vascular surgeons use minimally invasive procedures such as the MILLER procedure to correct steal syndrome and return your access to its proper function.

At Azura Vascular Care, we work every day to deliver far more than our patients expect. We bring our full range of medical capabilities and service excellence to every patient, every visit.  Each of our centers offer local knowledge coupled with a nationwide theme to always strive to provide superior care and an exceptional patient experience.

If you would like to learn more about a specific medical condition leading to dialysis, or about dialysis itself, Fresenius Kidney Care is a complete resource for CKD.

If you are ready to consult with one of our specialists, find a center near you or search for one of our physicians.

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