Fig. 1

a Retrograde percutaneous access was obtained through the venous outflow limb of the brachiocephalic AVF and a 6-French sheath was placed. b A guidewire is negotiated across the anastomosis retrogradely into the inflow brachial artery and the juxta-anastomotic venous outflow limb diameter is measured at 13 mm (arrow). c Following this, a 5 × 40 mm angioplasty balloon was inflated to nominal pressure and (d) blunt dissection was performed carefully on either side of the venous outflow limb. e-h The venous outflow limb was stenosed to the profile of the inflated balloon using a constraining 2–0 suture. i Completion fistulogram showing stenosis in the outflow vein (black arrow) and improvement in perfusion of the brachial artery distal to the anastomosis (white arrow) as well as to the hand