Subclavian steal syndrome from high-output brachiocephalic arteriovenous fistula: A previously undescribed complication of dialysis access

A 28-year-old dialysis-dependent man presented with episodic vertebrobasila r insufficiency. Noninvasive studies demonstrated an estimated 5.8 L/min fl ow through the arteriovenous fistula in his left arm and reversal of flow i n the left vertebral artery. Surgical reduction of fistula flow resulted in the elimination of symptoms and the return of antegrade flow in the left v ertebral artery. Intraoperative invasive monitoring corroborated the pressu re gradient responsible for his subclavian steal syndrome.