Subclavian Steal Phenomenon due to Arteriovenous Hemodialysis Fistula in the Arm: Report of a Case

We report a case of reversed vertebral artery blood flow in a patient with hemodialysis arteriovenous fistula. The patient was a 65-year-old woman who had been diagnosed as having chronic glomerulonephritis and hypertension at the age of 42. The arteriovenous fistula for hemodialysis had been made in her left arm when she was 62 years old. We carried out initial Doppler sonography vascular evaluation of the neck in June 1999. This showed that blood flow in the vertebral arteries was antegrade bilaterally with a maximum flow velocity of 73.0 cm/s in the right and 42.6 cm/s in the left. We re-evaluated the patient in January 2001 and found that the blood flow was retrograde in the left vertebral artery, with a maximum flow velocity of 60.7 cm/s. During compression of the left brachial artery, the left vertebral artery flow became antegrade. The patient had no signs or symptoms suggesting vertebrobasilar insufficiency.We consider that the reversed left vertebral flow in this case was a subclavian steal phenomenon caused by the arteriovenous fistula in the patient's arm. We suggest that Doppler evaluation of vertebral artery blood flow is useful in patients with arteriovenous fistulas for hemodialysis.