Subclavian Steal in a Patient With Hemodialysis Access in the Left Arm

Abstract

Subclavian steal is caused by pressure gradient reversal in the vertebral artery, in situations such as blood flow increase in a distal subclavian artery or subclavian arterial stenosis proximal of vertebral artery branching. Reports on subclavian steal caused by an internal shunt in the forearm are scarce. A 68-year-old man, diagnosed with hypertension and renal failure at ages of 42 and 46 years, respectively, was started on hemodialysis at the age of 49 years after an internal shunt construction in the left forearm. He underwent a neurological examination for the first time in our hospital, which revealed no abnormality. Brain magnetic resonance imaging demonstrated few lacunar infarctions and white matter lesions. No micro bleeds were observed. Magnetic resonance angiography revealed mild arteriosclerosis without major stenosis or occlusion. Continuous backflow in the left vertebral artery in both systolic and diastolic phases was detected on carotid ultrasound. Subclavian steal caused by an internal shunt is relatively rare, and symptomatic subclavian steal syndrome caused by an internal shunt is rarer. Nevertheless, as this pathology is iatrogenic, it needs appropriate care.