Surgically created arteriovenous fistula is a widely used form of treatment for end-stage renal disease. Even though it causes hemodynamic changes, they are not sufficient to produce significant alteration in the local as well as systemic circulation. The venous outflow has a crucial importance in the functioning of the fistula. Venous circulation is usually subjected to repeated injury in patients with chronic or critical illnesses. We present here a case in which sequential attempts to obtain angio access were unsuccessful due to bilateral axillary-sub clavian vein thrombosis, causing severe outflow obstruction and venous hyper tension. The role of angiography is to be considered in these situations.
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