Journal of Ultrasound in Medicine, Vol 17, Issue 12 759-763, Copyright © 1998 by American Institute of Ultrasound in Medicine
Volumetric measurements of the brachial and carotid arteries in dialysis grafts: is there evidence of a subclavian-carotid artery steal syndrome?
B. M. Eicke, C. Berwig, W. Wigger and W. Paulus
Department of Clinical Neurophysiology, Georg-August University Gottingen, Germany.
Dialysis grafts may lead to major hyperperfusion in the graft arm and to
hypertrophic, hypervolemic cardiomyopathy. No data have been published
concerning the impact of dialysis grafts on the cerebral perfusion in
relation to a potential carotid steal syndrome, possibly causing neurologic
or neuropsychologic symptoms. In 30 patients (32 to 74 years old) with
dialysis grafts we studied the following hemodynamic parameters in the
brachial and common carotid arteries bilaterally: Flow velocities (spectral
Doppler sonography), diameter (B-mode) and volume flow (color M-mode) with
a color duplex system (Philips P700). Volume flow in the brachial arteries
of the graft arm averaged 1032 ml/min (range, 158 to 2854 ml/min) as
compared to 42 ml/min (range, 15 to 108 ml/min) in the nongraft arm. Almost
identical volume flow data could be seen in both common carotid arteries
(418 versus 421 ml/min) with no evidence of reduced flow in the carotid
arteries in patients with high flow in the graft arm. A tendency toward
higher volume flow in both carotid arteries in patients with high volume
flow in the graft arm was noted. We found no evidence of shunt-induced
cerebral hypoperfusion. Cerebral autoregulation appears to be patent even
with high brachial artery shunt volume.
