Hand Ulcer due to HD-AVF Venous Outflow Obstruction

Case report of a hand ulcer caused by venous hypertension secondary to a hemodialysis AVF outflow obstruction. Duplex evaluation was repeatedly omitted by three vascular surgeons in favor of CTA, as they diagnosed the case by first impression as a central venous stenosis. Duplex vascular ultrasound is an invaluable tool in the hands of the vascular specialist and can add real time diagnostic information that other static modalities cannot.