Title
An Interesting Observation Regarding Retrograde Vertebral Artery Flow in Patients With Dialysis Access Fistulas
Publication Date
2019
Journal Title
JOURNAL OF ULTRASOUND IN MEDICINE
Abstract
© 2019 by the American Institute of Ultrasound in Medicine. OBJECTIVES: Retrograde vertebral artery flow, the steal phenomenon, is most frequently caused by a flow-limiting stenosis of the proximal subclavian artery. The reversal of flow can be incomplete, resulting in bidirectional flow: retrograde in systole and antegrade in diastole. Less often, retrograde vertebral artery flow is the consequence of increased subclavian flow, as might occur with a well-functioning dialysis access fistula. Our objective was to evaluate bidirectional vertebral artery flow associated with dialysis access fistulas. METHODS: We retrospectively reviewed the direction of flow through the vertebral artery in systole and diastole of 335 patients with dialysis fistulas who had undergone extracranial cerebral vascular Doppler examinations. RESULTS: Fifteen patients had retrograde flow in their vertebral artery ipsilateral with the side of their fistula. There was completely reversed flow in 1 patient and bidirectional flow in the other 14. For each of these 14, the flow was antegrade in early systole and retrograde in diastole. Compression of the fistula restored the antegrade flow. CONCLUSIONS: Under conditions of reduced subclavian artery flow, bidirectional vertebral artery flow will be retrograde in early systole and antegrade in diastole. Under conditions of increased subclavian artery flow, bidirectional flow through the vertebral artery will be antegrade in early systole and retrograde in diastole.
Volume Number
38
Issue Number
10
Pages
2703 - 2707
Document Type
Article
Status
Faculty
Facility
School of Medicine
Primary Department
Radiology
Additional Departments
Medicine, Pediatrics, Surgery
PMID
30803003
DOI
10.1002/jum.14975
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