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논문분류	춘계학술대회 초록집
제목	Subclavian Steal Syndrome Presenting as Neurological Symptoms and Access Dysfunction in a Hemodialysis Patient: A Case Report
저자	Sangeon Gwoo
출판정보	2026; 2026(1):
키워드	Interventional nephrology, arteriovenous access, Subclavian steal syndrome, Subclavian artery stenosis
초록	Case Study: A 79-year-old male with diabetic nephropathy-induced end-stage renal disease presented with a weak thrill in his left brachiocephalic arteriovenous fistula (AVF), created two months prior. Despite prior clinic visits, no interventions had been performed. The patient reported worsening symptoms post-dialysis, including slurred speech, blurred vision, and severe dizziness persisting until the next day, even with minimal ultrafiltration. He also noted a history of lower blood pressure in his left arm. Doppler ultrasound of the brachial artery revealed a flow volume of 688 ml/min and a significantly delayed acceleration time (0.23 seconds), suggesting upstream arterial stenosis. His neurological symptoms indicated posterior cerebral hypoperfusion. We hypothesized that the AVF creation increased left upper extremity blood demand, triggering a steal phenomenon via the vertebral artery and compromising posterior cerebral perfusion. Retrograde angiography via the AVF confirmed severe left subclavian artery stenosis and restricted antegrade vertebral artery flow, confirming the diagnosis of Subclavian Steal Syndrome (SSS). The patient underwent successful subclavian artery stenting, which markedly improved both his neurological symptoms and access blood flow. Subclavian artery stenosis is more prevalent in chronic kidney disease patients with arterial comorbidities. Neurological symptoms in hemodialysis patients are often non-specific, easily leading to underdiagnosis. This case emphasizes the necessity of routine bilateral blood pressure measurement before AVF creation to prevent SSS. Furthermore, clinicians must maintain a high index of suspicion for SSS when hemodialysis patients present with posterior cerebral symptoms.
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