Asymptomatic high flow subclavian steal in a patient with hemodialysis access.
BACKGROUND
Subclavian steal phenomenon due to proximal subclavian artery stenosis or occlusion is not un-common but often remains asymptomatic.


METHODS
We describe the case of a 66-year-old man with end-stage renal disease hemodialysed through a brachio-brachial loop graft of the left forearm. Echo-Doppler precerebral examination showed a high reversed flow of 570 ml/min in the ipsilateral vertebral artery. After successful endovascular recanalization of the subclavian artery, access blood flow increased and vertebral flow decreased to 30 ml/min. Complete neurological examination was normal both before and after endovascular treatment.


CONCLUSIONS
This case demonstrates how high a subclavian steal can be without causing symptoms and how well precerbral and cerebral circulation can adapt to hemodynamic changes.
Bron
Cédric
C
Department of Vascular Medicine, Centre Hospitalier Universitaire Vaudois, Switzerland. Cedric.Bron@chuv.ch
Hirt
Lorenz
L
Halabi
Georges
G
Saucy
François
F
Qanadli
Salah D
SD
Haesler
Erik
E
D000222:Adaptation, Physiological; D000368:Aged; D000800:Angioplasty, Balloon; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D002560:Cerebrovascular Circulation; D006439:Hemodynamics; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D012039:Regional Blood Flow; D006435:Renal Dialysis; D013349:Subclavian Steal Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D034941:Upper Extremity / Q000098:blood supply*