[Subclavian Steal Syndrome and Cerebral Hypoperfusion during Hemodialysis: A case report]

Subclavian steal syndrome is caused by retrograde vertebral artery flow "stealing" vertebrobasilar perfusion. We report the clinical case of a 53 year-old dialysis dependent woman with several cardiovascular risk factors, who had episodes of vertebrobasilar insufficiency and resting pain of the left upper extremity, during hemodialysis sessions, through a left arm brachiobasilic arteriovenous fistula. Noninvasive studies demonstrated a preoclusive stenosis at the origin of left subclavian artery, together with a stenosis on the left internal carotid artery superior to 70% and reversion of flow in the left vertebral artery. The patient underwent endarterectomy and Dacron patch angioplasty of the left internal carotid artery and carotid-subclavian ePTFE bypass, with total resolution of the previously described clinical presentation.