Vascular Rupture After Banding for High-Flow Arteriovenous Fistula: A Multicenter Case Series.

High-flow arteriovenous fistula often goes unnoticed during long-term dialysis in patients with chronic kidney failure until complications arise. The banding procedure is a commonly used method to reduce flow currently. However, data on rare but serious adverse events remain limited. This multicenter case series describes 6 patients who developed vascular rupture following banding for high-flow access, including 5 early and 1 late event. A suture-related cutting effect on dilated, high-tension vessels may be an explanation, although this remains speculative. Although previous studies have reported favorable outcomes with the Minimally Invasive Limited Ligation Endoluminal-assisted Revision and related banding techniques, our cases indicate that vascular rupture can still occur after banding for high-flow access and may be clinically serious. Further studies are warranted to better define its incidence and elucidate the underlying mechanisms.Clinical ImpactThis multicenter case series highlights that vascular rupture may occur after banding for high-flow AVFs, including early events (15-33 days) and a late event at 2 years. For clinicians, the immediate implication is heightened awareness and individualized patient selection, with particular caution in patients with markedly dilated outflow veins (>5 mm, especially approaching 10 mm) or vascular calcification. When these features are present, consider alternatives to a tight circumferential ligature-such as partial vessel excision with direct closure or a short synthetic graft-and implement close postoperative surveillance (flow, access exam, and blood pressure control).