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

To evaluate the clinical feasibility and safety of a 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 ± 16.6 years; male: 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 patients. Mean access flow decreased from 2516 ± 1118 mL/min to 921 ± 227 mL/min, and venous diameter decreased from 8.20 ± 2.23 mm to 4.28 ± 0.70 mm (both P < 0.001). 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.