Failed MILLER Banding Complicated by Pseudoaneurysm: Report of a Case

We present a case in which Minimally Invasive Limited Ligation Endoluminal-assisted Revision (MILLER) banding was complicated by the development of a pseudoaneurysm at the site of attempted banding. A patient with a high-flow fistula and symptoms of distal arterial hypoperfusion underwent Miller banding. Six weeks post-Miller banding, the patient's symptoms of hand pain returned gradually and a pseudoaneurysm appeared at the banding site. The remedial surgical procedure revealed a banding suture that had passed through one wall of the vessel and was floating in the pseudoaneurysm cavity. A primary lateral repair of the pseudoaneurysm was performed and the inflow was rebanded over a 4 mm balloon. The patient is now 51 months postpseudoaneurysm repair and the fistula continues to be used for dialysis access. Perforation of the fistula should be suspected when there is more bleeding than usual during the MILLER banding procedure.