Clinical features, early diagnosis and management of subclavian artery stenosis in hemodialysis patients.

BACKGROUND

Subclavian artery stenosis (SAS) in hemodialysis (HD) patients often presents as non-specific arteriovenous access (AVA) dysfunction. Early recognition is critical to preserve access patency.

METHODS

This retrospective study included HD patients with newly diagnosed SAS from 2018 to 2024. Clinical features, imaging findings, treatments, and changes in AVA flow after technically successful endovascular therapy were analyzed.

RESULTS

Seventeen patients were included. AVA dysfunction (82.4%) and ipsilateral limb ischemia (52.9%) were common. Mean systolic inter-arm pressure difference was 32.5 mm Hg; 69.2% had retrograde or bidirectional vertebral flow. Endovascular treatment achieved 92.3% technical success and increased AVA flow from 570.5 to 1001.2 mL/min (p < 0.001). No recurrent symptoms occurred.

CONCLUSIONS

In HD patients, SAS commonly presents with ischemic and AVA-related symptoms. Endovascular revascularization is effective and rapidly improves hemodynamics and symptoms.