Abstract
We present a rare cause of subclavian steal syndrome secondary to a dialysis arteriovenous fistula (AVF). A 69-year-old female with end-stage renal disease presented with ataxia and recurrent fainting spells. Angiography revealed normal subclavian arteries bilaterally, a right VA origin occlusion, and an apparent left VA origin occlusion. However, carotid artery angiography demonstrated flow through the posterior communicating artery with retrograde filling of the basilar artery and left VA to its subclavian origin. Repeat left subclavian arteriography during external compression of the AVF demonstrated normal antegrade left VA flow. The AVF was subsequently ligated resulting in complete symptom resolution.
Highlights
Subclavian steal is the reversal of flow in a vertebral artery (VA) due to stenosis or extrinsic compression of the ipsilateral innominate or subclavian artery proximal to the VA origin
We present a rare cause of subclavian steal syndrome secondary to a dialysis arteriovenous fistula (AVF)
Subclavian steal phenomenon (SSP) is a benign vascular hemodynamic condition characterized by reversal of flow in the VA due to stenosis or occlusion of ipsilateral innominate or subclavian artery proximal to the origin of VA
Summary
Subclavian steal is the reversal of flow in a vertebral artery (VA) due to stenosis or extrinsic compression of the ipsilateral innominate or subclavian artery proximal to the VA origin. Subclavian artery stenosis is typical, subclavian steal syndrome may occur with a normal subclavian artery. We present a rare cause of subclavian steal syndrome secondary to a dialysis arteriovenous fistula (AVF). To our knowledge, this is the third case reported in the literature
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