Venous Hypertension in the Hand and Forearm after Brachioaxillary Graft Formation

We describe a patient on long term haemodialysis with signs of venous hypertension in the hand and forearm, but not the upper arm. This was caused by a venous outflow stenosis of a brachioaxillary graft. Duplex ultrasound and fistulogram showed a venous outflow stenosis with a large collateral feeding the forearm veins. The symptoms improved rapidly after revision of the anastomosis. Striking was the lack of signs in the upper arm despite the stenosis being in the axilla. The filling of the forearm venous system via the deep brachial veins lead to signs of venous hypertension in the forearm only.