title: Vertebral and internal mammary artery steal syndrome in patients with hemodialysis access.
abstract: BACKGROUND
  Increased flow in the subclavian artery feeding a vascular access for hemodialysis can induce steal phenomena in the vertebral (VA) and internal mammary artery (IMA). The aim of this study was to describe the hemodynamic effects of access flow on the VA and IMA in patients with native fistulas and grafts.
  
  
  METHODS
  Peak systolic (PSV) and end diastolic (EDV) velocity measurements of the VA, IMA and carotid arteries, as well as flow volume measurements of the subclavian artery, were performed. Flow measurements at the side of the vascular access were compared with the contralateral side. Fifty-five patients were consecutively included, most with a radio-cephalic fistula on the left arm with a mean shunt volume of 1156 ml/min.
  
  
  RESULTS
  Pathologic flow patterns were observed in the ipsilateral VA in four patients (7.3 %); contralateral VA flow was normal in all patients. Peak systolic velocity of the VA was significantly decreased at the side of the shunt arm with a PSV of 42.6 ± 11.8 cm/s compared to 48.4 ± 15.6 cm/s contralateral (p < 0.05). The IMA flow pattern were normal in all patients. The PSV of the IMA was significantly decreased (p < 0.01) at the side of the shunt arm (87.5 ± 29.1 cm/s) compared to the non-shunt arm (95.9 ± 27.4 cm/s).
  
  
  CONCLUSIONS
  We describe significant hemodynamic effects of fistulas to the vertebral and internal mammary arteries. Doppler spectral analysis of the vertebral and internal mammary arteries should be integrated in ultrasound, especially in patients with cerebrovascular or cardiac symptoms.
authors.affiliation: 1 Clinic for Angiology, University Hospital Zürich and University of Zürich, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Thalhammer
authors.affiliation: 1 Clinic for Angiology, University Hospital Zürich and University of Zürich, Switzerland.
authors.forename: Robert K
authors.initials: RK
authors.lastname: Clemens
authors.affiliation: 1 Clinic for Angiology, University Hospital Zürich and University of Zürich, Switzerland.
authors.forename: Marie-Luise
authors.initials: ML
authors.lastname: Valentin
authors.affiliation: 1 Clinic for Angiology, University Hospital Zürich and University of Zürich, Switzerland.
authors.forename: Elena
authors.initials: E
authors.lastname: Alonso
authors.affiliation: 2 Clinic for Nephrology, University Hospital Zürich and University of Zürich, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Segerer
authors.affiliation: 1 Clinic for Angiology, University Hospital Zürich and University of Zürich, Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Husmann
authors.affiliation: 1 Clinic for Angiology, University Hospital Zürich and University of Zürich, Switzerland.
authors.forename: Beatrice R
authors.initials: BR
authors.lastname: Amann-Vesti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001783:Blood Flow Velocity; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008323:Mammary Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008875:Middle Aged; D011237:Predictive Value of Tests; D012039:Regional Blood Flow; D006435:Renal Dialysis; D012307:Risk Factors; D013349:Subclavian Steal Syndrome / Q000209:etiology / Q000503:physiopathology; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014715:Vertebrobasilar Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology
keywords: Duplex ultrasound; Vertebral steal syndrome; hemodialysis access; internal mammary artery