Subclavian Steal
Conditions
Keywords
subclavian steal, carotid duplex, subclavian stenosis, hemodialysis with vascular access in the upper limbs, the focus of this study is to see if duplex can be used as an tool to differentiate the different causes of subclavian steal syndromes
Brief summary
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.
Detailed description
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.
Interventions
DEVICEcarotid duplex
Carotid duplex in the differential diagnosis of subclavian steal syndrome due to Arteriovenous Hemodialysis access in the Ipsilateral arm
Sponsors
Mennonite Christian Hospital
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
DIAGNOSTIC
Masking
NONE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
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
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change of Subclavian Flow to Normal Flow Pattern During Cuff Test | two years | we used carotid duplex duplex to study the change of subclavian arterial flow during cuff test to see if there is any difference between normal participants and patients under hemodialysis. There are two patterns seen. One is that the subclavian arterial flow reversed to normal flow pattern during cuff test. The other is that there is no change of subclavian flow pattern when the flow is stopped in the arm by cuff test. |
| no Change of Subclavian Arterial Flow During Cuff Test | one year | we used carotid duplex duplex to study the change of subclavian arterial flow during cuff test to see if there is any difference between normal participants and patients under hemodialysis. There are two patterns seen. One is that the subclavian arterial flow reversed to normal flow pattern during cuff test. The other is that there is no change of subclavian flow pattern when the flow is stopped in the arm by cuff test. |
| Change of Vertebral Flow to Normal Flow Pattern During Cuff Test | two year | we used carotid duplex duplex to study the change of vertebral arterial flow during cuff test to see if there is any difference between normal participants and patients under hemodialysis. There are two patterns seen. One is that the vertebral arterial flow reversed to normal flow pattern during cuff test. The other is that there is no change of vertebral flow pattern when the flow is stopped in the arm by cuff test. |
| no Change of Vertebral Arterial Flow During Cuff Test | 2 years | we used carotid duplex duplex to study the change of vertebral arterial flow during cuff test to see if there is any difference between normal participants and patients under hemodialysis. There are two patterns seen. One is that the vertebral arterial flow reversed to normal flow pattern during cuff test. The other is that there is no change of vertebral flow pattern when the flow is stopped in the arm by cuff test. |
Countries
Taiwan
Participant flow
Recruitment details
enroll patients from Dec 2010 to July 2011. all enrolled patients have been studied by carotid duplex in Mennonite Christian hospital.
Pre-assignment details
one patient with vascular access has been ruled out after enrollment for the subclavian artery revealed normal blood flow in duplex.
Participants by arm
| Arm | Count |
|---|---|
| Carotid Duplex for Nonhemodialytic Patients Wtih SSS using carotid duplex (with cuff test) to study vertebral and subclavian artery to see the difference of flow during and after occlusion of blood vessel in the arm by cuff test | 5 |
| Carotid Duplex for Hemodialytic Patients With SSS After receiving written consent from patients with vascular access in the forearm, carotid duplex was done to especially see the flow pattern and direction of flow of vertebral artery and subclavian artery in the ipsilateral side of vascular access during and after the stop of flow in the arm by cuff test. | 2 |
| Total | 7 |
Baseline characteristics
| Characteristic | Carotid Duplex for Hemodialytic Patients With SSS | Carotid Duplex for Nonhemodialytic Patients Wtih SSS | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 0 Participants | 2 Participants | 2 Participants |
| Age, Categorical Between 18 and 65 years | 2 Participants | 3 Participants | 5 Participants |
| Age Continuous | 52.5 years STANDARD_DEVIATION 0.7 | 62.6 years STANDARD_DEVIATION 9.53 | 59.71 years STANDARD_DEVIATION 9.21 |
| Region of Enrollment Taiwan | 2 participants | 5 participants | 7 participants |
| Sex: Female, Male Female | 1 Participants | 1 Participants | 2 Participants |
| Sex: Female, Male Male | 1 Participants | 4 Participants | 5 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 5 | 0 / 11 |
| serious Total, serious adverse events | 0 / 5 | 0 / 11 |
Outcome results
Primary
Change of Subclavian Flow to Normal Flow Pattern During Cuff Test
we used carotid duplex duplex to study the change of subclavian arterial flow during cuff test to see if there is any difference between normal participants and patients under hemodialysis. There are two patterns seen. One is that the subclavian arterial flow reversed to normal flow pattern during cuff test. The other is that there is no change of subclavian flow pattern when the flow is stopped in the arm by cuff test.
Time frame: two years
Population: for there are not too many patients who have subclavian steal found by carotid duplex, we just collected all patients during the study period that have subclavian steal and all patients with vascular access that signed written consent for the examination.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Normal Parcipitants With Subclavian Steal | Change of Subclavian Flow to Normal Flow Pattern During Cuff Test | 0 participants |
| Hemodialytic Patients With Subclavian Steal | Change of Subclavian Flow to Normal Flow Pattern During Cuff Test | 2 participants |
Primary
Change of Vertebral Flow to Normal Flow Pattern During Cuff Test
we used carotid duplex duplex to study the change of vertebral arterial flow during cuff test to see if there is any difference between normal participants and patients under hemodialysis. There are two patterns seen. One is that the vertebral arterial flow reversed to normal flow pattern during cuff test. The other is that there is no change of vertebral flow pattern when the flow is stopped in the arm by cuff test.
Time frame: two year
Population: determined as above explained
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Normal Parcipitants With Subclavian Steal | Change of Vertebral Flow to Normal Flow Pattern During Cuff Test | 0 participants |
| Hemodialytic Patients With Subclavian Steal | Change of Vertebral Flow to Normal Flow Pattern During Cuff Test | 2 participants |
Primary
no Change of Subclavian Arterial Flow During Cuff Test
we used carotid duplex duplex to study the change of subclavian arterial flow during cuff test to see if there is any difference between normal participants and patients under hemodialysis. There are two patterns seen. One is that the subclavian arterial flow reversed to normal flow pattern during cuff test. The other is that there is no change of subclavian flow pattern when the flow is stopped in the arm by cuff test.
Time frame: one year
Population: for there are not too many patients who have subclavian steal found by carotid duplex, we just collected all patients during the study period that have subclavian steal and all patients with vascular access that signed written consent for the examination.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Normal Parcipitants With Subclavian Steal | no Change of Subclavian Arterial Flow During Cuff Test | 5 participants |
| Hemodialytic Patients With Subclavian Steal | no Change of Subclavian Arterial Flow During Cuff Test | 0 participants |
Primary
no Change of Vertebral Arterial Flow During Cuff Test
we used carotid duplex duplex to study the change of vertebral arterial flow during cuff test to see if there is any difference between normal participants and patients under hemodialysis. There are two patterns seen. One is that the vertebral arterial flow reversed to normal flow pattern during cuff test. The other is that there is no change of vertebral flow pattern when the flow is stopped in the arm by cuff test.
Time frame: 2 years
Population: as above explained
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Normal Parcipitants With Subclavian Steal | no Change of Vertebral Arterial Flow During Cuff Test | 5 participants |
| Hemodialytic Patients With Subclavian Steal | no Change of Vertebral Arterial Flow During Cuff Test | 0 participants |