Cephalic arch stenosis masquerading as carotid jugular arteriovenous fistula with a thrill in the neck

Autogenous arteriovenous fistulae creation (AVFs) is the gold standard technique for permanent haemodialysis access. However, AVF stenosis is a common problem and a major cause of fistula dysfunction. Juxta-anastomotic stenosis is the most frequent reason for AVF dysfunction. In brachiocephalic AVF, type 3 stenosis have been identified in up to 40% of failing fistulae [2]. Due to their location in the most proximal portion of the cephalic vein, they are also called cephalic arch stenosis (CAS). CAS remains a major problem among these patients and they may present to the clinician with a diverse symptom.