Central venous stenosis is a relatively common problem in patients on long term haemodialysis through an AV fistula in the upper limb and may be seen in up to 40% of patients. 

The clinical presentation may vary - poor flow rates at dialysis needing longer hours of dialysis, limb swelling etc.

Interventional radiology offers a good option of management of such cases either by percutaneous transluminal balloon angioplasty or stent placement. Post stenting there is a risk of in-stent restenosis due to high flows at the dialysis and at the AV fistula. In-stent restenosis can be treated by balloon angioplasty.

This case demonstrates the use of balloon angioplasty in treating in-stent restenosis.