Subclavian steal syndrome from high-output brachiocephalic arteriovenous fistula: A previously undescribed complication of dialysis access W.G. Schenk,

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Presentation transcript:

Subclavian steal syndrome from high-output brachiocephalic arteriovenous fistula: A previously undescribed complication of dialysis access W.G. Schenk, MD Journal of Vascular Surgery Volume 33, Issue 4, Pages 883-885 (April 2001) DOI: 10.1067/mva.2001.111994 Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 1 Gross appearance of enlarged left upper extremity brachial artery to cephalic vein fistula. Massive dilatation of artery and cephalic vein conduit can be appreciated percutaneously. Patient previously had both an autologous fistula and prosthetic graft in left forearm, such that upper-arm cephalic vein had been the outflow for an arteriovenous anastomosis continuously for 20 years. Journal of Vascular Surgery 2001 33, 883-885DOI: (10.1067/mva.2001.111994) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 2 Arch aortogram demonstrates no central abnormality in the arch vessels. White arrow , Antegrade flow in dilated left subclavian artery. Black arrow, Rapid opacification of the left subclavian vein. Asterisk indicates no antegrade flow in left vertebral artery. Journal of Vascular Surgery 2001 33, 883-885DOI: (10.1067/mva.2001.111994) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 3 Selective right vertebral artery arteriogram demonstrates retrograde flow in left vertebral artery through vertebrobasilar system. Asterisk indicates contrast washout into left subclavian artery. Journal of Vascular Surgery 2001 33, 883-885DOI: (10.1067/mva.2001.111994) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 4 Intraoperative direct pressure tracings from left subclavian artery during flow reduction in left arm arteriovenous fistula. Before revision there is a peak of 76 mm Hg and mean gradient of 57 mm Hg (A ). After creation of iatrogenic 75% stenosis in fistula inflow, peak gradient has been reduced to 34 mm Hg, and mean gradient has been reduced to 25 mm Hg (B ). This resulted in an estimated total flow reduction from 5.8 to 1.9 L/min, and fistula remains patent and adequate for dialysis on 1-year follow-up. Journal of Vascular Surgery 2001 33, 883-885DOI: (10.1067/mva.2001.111994) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions