Vol. 7, Issue 2, Part A (2025)

Introduction: Dialysis Access Steal Syndrome (DASS) complicates 1-8% of arteriovenous fistulas (AVFs), ranging from mild ischemic discomfort to severe limb-threatening ischemia (1).
Case Presentation: We describe a 47-year-old male with end-stage renal disease (ESRD) on hemodialysis, presenting with classical symptoms of DASS in a right brachiocephalic AVF, without significant inflow arterial stenosis.
Intervention: A hybrid Minimally Invasive Limited Ligation Endoluminal-Assisted Revision (MILLER) procedure was performed, combining surgical ligation with balloon-assisted intraoperative calibration to reduce fistula diameter and restore distal arterial flow (2). Central venous occlusion was concurrently managed with balloon angioplasty and stenting.
Outcome: The procedure relieved ischemic symptoms, normalized distal saturation, and preserved vascular access.
Conclusion: The MILLER technique represents a safe and effective option for managing DASS in patients requiring fistula preservation (2, 3).