Asymptomatic High Flow Subclavian Steal in a Patient with Hemodialysis Access

Abstract

Introduction

Subclavian steal phenomenon due to proximal subclavian artery stenosis or occlusion is not uncommon but often remains asymptomatic.

Case Report

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.

Discussion

This case demonstrates how high a subclavian steal can be without causing symptoms and how well precerebral and cerebral circulation can adapt to hemodynamic changes.