Asymptomatic high flow subclavian steal in a patient with hemodialysis access

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. (J Vasc Access 2010; 11: 63-5)