Targeted banding technique for the release of normal-flow radial-cephalic arteriovenous fistula with hemodialysis access-induced distal ischemia: A case report

Hemodialysis access-induced distal ischemia (HAIDI) is a complication that can occur following arteriovenous fistula (AVF) surgery, often leading to symptoms such as pain, numbness, and coldness in the affected hand. While HAIDI is commonly associated with high-flow AVFs originating from the brachial artery, management options for normal-flow radial-cephalic arteriovenous fistulas (RC-AVFs) in the forearm remain limited. We present a case of acute stage III HAIDI in a patient with a proximal RC-AVF. The patient was treated with a minimally invasive, ultrasound-guided targeted banding technique, which successfully relieved the symptoms and restored blood flow to the distal ulnar artery. This intervention not only provided rapid symptom relief but also extended the cumulative patency time of the AVF. This case highlights the importance of thoroughly assessing the risk of HAIDI and demonstrates the potential of targeted banding as an effective treatment for HAIDI in normal-flow RC-AVFs.