Subclavian steal syndrome in a hemodialysis patient after percutaneous transluminal angioplasty of arteriovenous access

Kaneko, Yoko; Yanagawa, Takamoto; Taru, Yoshinori; Hayashi, Sonoko; Zhang, Hong; Tsukahara, Tomoki; Matsunaga, Tsuneaki; Ishizu, Tomoko

doi:10.1177/1129729818761279

Cited by 11 publications

(12 citation statements)

References 9 publications

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“…A decrease in renal resistive index of kidney transplant after AVF compression, suggesting an increase in transplant perfusion, has been observed. 14 As to the brain, one case report described symptomatic subclavian steal syndrome via an arteriovenous access in a patient who developed high-flow AVF after having undergone percutaneous transluminal angioplasty (PTA) for AVF stenosis, 15 but whether a normal-flow AVF can cause mild asymptomatic steal syndrome is not known.…”

Section: Discussionmentioning

confidence: 99%

Short-term manual compression of hemodialysis fistula leads to a rise in cerebral oxygenation

et al. 2020

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Background: Decreased cerebral perfusion and oxygenation are common in hemodialysis patients. Magnitude of the arteriovenous fistula involvement in this phenomenon is not known. The aim of this study was to investigate the effect that a short-term arteriovenous fistula flow interruption has on cerebral oxygenation and to review and suggest possible explanations. Methods: In 19 patients, basic laboratory and clinical data were obtained and arteriovenous fistula flow volume was measured by ultrasonography. Baseline regional cerebral oxygen saturation (rSO2) was measured by near-infrared spectroscopy. Manual pressure was then applied on the fistula, resulting in total blood flow interruption. After 1 min of manual compression, rSO2 and blood pressure values were noted again. The compression-related change in rSO2 was assessed, as well as its association with arteriovenous fistula flow volume, blood pressure, and other parameters. Results: Mean cerebral rSO2 increased after arteriovenous fistula compression (from 53.6% ± 11.4% to 55.6% ± 10.8%; p = 0.000001; 95% confidence interval = 1.39–2.56). The rSO2 increase was higher in patients with lower rSO2 at baseline (r = −0.46; p = 0.045). Conclusion: A significant rise in cerebral oxygenation was observed following the manual compression of arteriovenous fistula. Therefore, the arteriovenous fistula could have a role in impaired cerebral oxygenation in hemodialysis patients.

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Section: Discussionmentioning

confidence: 99%

Short-term manual compression of hemodialysis fistula leads to a rise in cerebral oxygenation

et al. 2020

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“…Sixty-six articles encompassing 940 patients fulfilled study criteria (mean age 56 years [3–90], male 62%). 5,6,13,18–81…”

Section: Resultsmentioning

confidence: 99%

“…Seven articles reporting on graft interposition were included (n = 46 patients, 64% male, mean age 60 ; Table 4). 48,64,67,[71][72][73][74] Qa drop was 1.6 l/min (2.9-1.3 l/min). Complications were reported in seven patients (15%), mostly thrombosis (n = 6).…”

Section: Graft Interposition Technique (Git)mentioning

confidence: 96%

A scoping review on surgical reduction of high flow arteriovenous haemodialysis access

et al. 2022

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Volume flow (Qa) > 1.5–2 l /minQa in arteriovenous accesses may be associated with high flow related systemic or locoregional complications. A variety of surgical techniques are advocated for Qa reduction. Aim of this scoping review is to provide an overview of available evidence regarding the efficacy of this broad spectrum of interventions for Qa reduction in patients with a high flow haemodialysis access. PubMed and Embase were searched according to PRISMA-guidelines. Studies on invasive management of HFA were selected. Inclusion required an English description of surgical techniques in human HFAs including pre- and postoperative access flow-values. Sixty-six studies on 940 patients (mean age 56 years (3–90 years), male 62%, diabetes mellitus 26%, brachial artery-based arteriovenous access 65%) fulfilled inclusion criteria. Performed techniques were banding (58%), revision using distal inflow (12%), plication/anastomoplasty (10%), graft interposition (5%), proximal radial artery ligation (3%), aneurysm repair (4%), or miscellaneous other techniques (8%). Definition of HFA, work-up, indication for surgery and intraoperative monitoring were diverse. All techniques reduced Qa on the short term (mean drop 0.9–1.7 l/min). Secondary access patency rates varied between 70% and 93% (mean follow-up 15 (0–189) months). Definitions of success and recurrence varied widely precluding a comparison of efficacy of techniques. Patient specific factors legitimizing invasive treatment for HFA are discussed. Recommendations on reporting standards when dealing with HFA surgery are provided. In conclusion, the present report on the current management of high flow access does not allow for drawing any definite conclusions due to a lack of standardization in definition, indications for surgical intervention and techniques. Randomized trials comparing different Qa reducing techniques in symptomatic patients are warranted, as are trials comparing a wait-and-see approach versus Qa reduction in asymptomatic patients. As an overview of the variety of techniques was lacking, this scoping review might serve as a map for future researchers.

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“…The primary intervention in such cases is percutaneous transluminal angioplasty with stenting [11,12]. Rarely, intravascular procedures can actually precipitate iatrogenic SSS due to prothrombotic vascular injury [13]. When coronary artery bypass procedures utilize an internal mammary artery (IMA) attached to a stenosed subclavian artery, it may "steal" blood from the IMA graft causing divertive retrograde flow in the graft due to increased demand in the affected limb during exertion.…”

Section: Figure 3: Mechanism Of Posterior Circulation Insufficiencymentioning

confidence: 99%

Recurrent Subclavian Steal Syndrome: A Novel Case of Vasculopathy

Leach¹,

Radwanski²,

Kaur³

et al. 2023

Cureus

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Subclavian steal syndrome (SSS) refers to the phenomenon of retrograde flow in an ipsilateral branch of the subclavian artery due to hemodynamically significant stenosis or occlusion of the ipsilateral proximal subclavian artery. While SSS is usually asymptomatic, it can manifest as vertebrobasilar insufficiency (VBI), ischemia of the affected extremity, or cardiac angina when an internal mammary artery (IMA) is used as a bypass graft. The underlying etiology is most often atherosclerosis but can include Takayasu arteritis, thoracic outlet syndrome, cervical rib, and stenosis secondary to surgical repair of aortic coarctation or tetralogy of Fallot.There are several case reports describing unique presentations of SSS as well as limited reports of double SSS, where the brachiocephalic steno-occlusive disease causes flow reversal in both the ipsilateral vertebral and carotid arteries. We report herein the first documented case, to our knowledge, of a patient with SSS previously treated with left subclavian artery stenting and left common carotid-subclavian bypass who developed recurrent SSS in conjunction with orthostatic cerebral hypoperfusion syndrome (OCHOS) secondary to severe vasculopathy. She presented with recurrent, paroxysmal vertigo and nearsyncope associated with left upper extremity paresthesias that would only abate with sitting in the context of left subclavian artery stent restenosis and occlusion of her left common carotid-subclavian bypass graft. Interestingly, her initial presentation entailed retrograde flow from the left vertebral artery to the left subclavian artery, classic for SSS, but recurrence of her SSS involved retrograde flow from the left common carotid artery to the left subclavian artery, a phenomenon which has also not been described in the literature to our knowledge. As her symptoms of VBI appeared to be triggered by standing and not left arm movement, they were considered to be primarily secondary to OCHOS. Consequently, her primary treatment was to increase salt and fluid intake and thus increase intravascular volume for improved cerebral perfusion as she was not deemed to be a suitable candidate for regrafting of the left subclavian artery.

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Subclavian steal syndrome in a hemodialysis patient after percutaneous transluminal angioplasty of arteriovenous access

Abstract: This case shows that percutaneous transluminal angioplasty for an arteriovenous fistula may induce subclavian steal syndrome, and a modified graft inclusion technique was useful in improving the high flow of an arteriovenous fistula.

Cited by 11 publications

References 9 publications

Short-term manual compression of hemodialysis fistula leads to a rise in cerebral oxygenation

Short-term manual compression of hemodialysis fistula leads to a rise in cerebral oxygenation

A scoping review on surgical reduction of high flow arteriovenous haemodialysis access

Recurrent Subclavian Steal Syndrome: A Novel Case of Vasculopathy

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