Differential Diagnosis for the Causes of Subclavian Steal for Patients With Vascular Access in the Forearm
Differential Diagnosis for the Causes of Subclavian Steal for Patients With Vascular Access in the Forearm
Subclavian steal phenomenon is normally observed in patients with stenosis of subclavian
 artery proximal to orifice of vertebral artery(V0). However, uremic patients undergoing
 hemodialysis using vascular access in the arm or forearm may also develop dialysis associated
 steal syndrome(DASS).For patients with symptomatic subclavian steal phenomenon, the treatment
 for these two groups is different. The investigators want to see if the investigators can use
 noninvasive duplex examination instead of invasive conventional angiography to do the
 differential diagnosis.
Carotid duplex is widely used for diagnosis of subclavian steal syndrome. We have a patient
 who suffered from acute brain stem stroke after receiving hemodialysis for months. He has DM
 related uremia and the vascular access is in the forearm. Subclavian steal was found on
 duplex in the same arm for hemodialysis. We used standard cuff test for diagnosis of
 subclavian steal by carotid duplex examination. Accidentally, we found the flow of subclavian
 artery was back to normal when the cuff is on that stops the flow. We want to see if this
 phenomenon can be used to serve as a differential diagnostic tool for differentiation of
 subclavian steal caused by stenosis of subclavian artery or due to DASS.
Inclusion Criteria:

 -  patients who revealed subclavian steal in the duplex study

 Exclusion Criteria:

 -  patients who has vascular access in the arm instead of the forearm