What do you do next?
So now that you have confirmed access recirculation and are worried about access stenosis, lets examine this access to look for abnormalities.
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 is your differential at this point?
Based on the findings of a water hammer pulse and howling bruit at the anastomosis, what do you think is the issue?