This is a case of end-stage renal disease on hemodialysis for a long time via right forearm radio-cephalic arterial-venous fistula. She had multiple interventional angioplasties to keep her fistula functioning for dialysis. Except for a tense aneurysmal dilatation on clinical examination her surveillance and clinical data are not indicative for any problems with the fistula. The author emphasizes the importance of clinical examination when evaluating the arterial-venous fistula and showed the shortcoming of clinical surveillance if not combined with monitoring and clinical examination.
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