A case of recurrent loss of consciousness due to vertebrobasilar insufficiency during the initiation of dialysis

Abstract

A 76‒year‒old male, who had end‒stage renal failure caused by contrast‒induced nephropathy, was admitted to our hospital due to congestive heart failure, after complaining of dyspnea. An arteriovenous fistula was created in his left arm. Emergent hemodialysis was performed with a central venous catheter. On the 4th hospital day, the patient fainted and convulsed for a few minutes during hemodialysis. Magnetic resonance angiography failed to visualize the basilar artery. Subclavian angiography showed occlusion of the origin of the right vertebral artery and severe ostial stenosis of the left vertebral artery. The patient was diagnosed with vertebrobasilar insufficiency (VBI). After percutaneous transluminal angioplasty and stenting for ostial stenosis of the left vertebral artery, angiography showed no further evidence of stenosis, and the patient did not faint again. It is extremely rare for VBI to occur during the initiation of dialysis.