For continuation of dialysis, the most common access created is arteriovenous fistula either distally in radiocephalic or proximally brachiocephalic fistula was at arm. However, the fistulous often developed multiple complications & flow through them either reduced or completely stopped. Most common of them either gradual reduction inflow which is becomes critical at times so that no more dialysis could be carried out through them or sudden acute occlusion of the fistula resulting in no dialysis access.

For such patients, to salvage the fistula there are several procedures which can be done resulting in longer patency of the fistula & continuation of dialysis access. Mostly the draining venous system which develops either tight narrowing may be shorter or longer length or developed clotting or thrombosis in them. These narrowings or stricture wire can the serially dilated resulting in flow via them & salvage of the fistula. In certain cases are clotting develops, through infusion catheter, drugs can be given to dissolve the clots if it is very early stage or can be taken out by aspiration of thrombectomy to open up the draining vein which is blocked.

In the present case, 45-year-old gentleman having a completely blocked left brachiocephalic fistula presented with suspicion of thrombosis of the draining vein but on preprocedural evaluation found to have small segment of thrombosis but longer segment of draining cephalic
venous stricture.

So, we decided to go ahead with the fistuloplasty of to salvage this fistula as possible. Via left radial artery approach a 6-French sheath placed & check INJ. Show complete cephalic venous long segment stricture with a small segment of thrombus. Using wire the narrowed portion of the cephalic vein approach & slowly crossed centrally over which serial dilatation slowly of the entire length of the stricture using 4 & 7 mm balloon done. Post-procedure excellent forward flow started & the fistula got functional again used, after 7 days of the procedure & it is still continuing.