What do you do next?
The dialysis machine is detecting high venous pressures. You are worried about access malfunction. Let’s examine this patient’s fistula.
Click on the hotspots 
below to get more information about this patient’s fistula. View in full screen by clicking the top right corner of the image. 
What do you think is going on?
Based on the clues from the dialysis machine (high venous pressure) and observations from the physical exam (hyperpulsatility and failed drainage on arm raising test), what do you think is going on?