Figure 2

Time-resolved dynamic CT angiography of a 57-year-old female patient with a complex failing arterio-venous forearm fistula. Image (A) shows only marginal contrast of the afferent radial artery with a stenosis 2 cm proximal to the arterio-venous forearm fistula and a collateral artery as a sign for a long term stenosis (arrows in B). Image (A) also demonstrates a very strong anterior interosseous artery (arrow head in A and E) also indicating a chronic stenosis. Further, the study revealed two venous aneurysms with a wall adherent thrombus directly located after the fistula (arrows in C). The venous return revealed only drainage over the deep perforator venous system without a connection to the cephalic vein (arrow in D). The main venous return is depicted in image (E) via a dilated superficial vein to the basilica vein. Duplex ultrasound images in F and G demonstrate the partially thrombotic aneurysm but do not reveal the stenosis proximal to the fistula, as well as the insufficient venous backflow to the cephalic vein.