Subclavian steal syndrome from high-output brachiocephalic arteriovenous fistula: a previously undescribed complication of dialysis access.
A 28-year-old dialysis-dependent man presented with episodic vertebrobasilar insufficiency. Noninvasive studies demonstrated an estimated 5.8 L/min flow through the arteriovenous fistula in his left arm and reversal of flow in the left vertebral artery. Surgical reduction of fistula flow resulted in the elimination of symptoms and the return of antegrade flow in the left vertebral artery. intraoperative invasive monitoring corroborated the pressure gradient responsible for his subclavian steal syndrome.
Schenk
W G
WG
Department of Surgery, University of Virginia Health System, Charlottsville, VA, USA. wgs@va.edu
D000328:Adult; D001132:Arm / Q000098:blood supply; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001783:Blood Flow Velocity; D001794:Blood Pressure; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D011859:Radiography; D006435:Renal Dialysis; D013348:Subclavian Artery / Q000503:physiopathology; D013349:Subclavian Steal Syndrome / Q000209:etiology* / Q000601:surgery; D014463:Ultrasonography; D014680:Veins / Q000000981:diagnostic imaging / Q000601:surgery; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology