Brachial-cephalic arteriovenous fistula with outflow stenosis

The individual shown has a brachial-cephalic fistula. Visible signs of outflow stenosis include a focal bruit over the stenotic region, hyperpulsatile and possibly aneurysmal fistula, and a systolic thrill and bruit overlying the anastomosis. The arm is not swollen as might be seen with central venous stenosis. A cephalic arch stenosis can bee seen on the fistulogram (dashed white arrow).