Fibromuscular dysplasia of the brachial artery causing hemodialysis access dysfunction

An 83-year-old woman with end-stage renal disease secondary to hypertension and left upper-arm arteriovenous graft dysfunction was found to have fibromuscular dysplasia (FMD) of the left brachial artery. The classic "string of beads" appearance on arteriography was suggestive of FMD. The lesion responded well to balloon angioplasty and required no further intervention. Although other lesions including venous outflow stenosis and central venous stenosis resulted in two further episodes of access dysfunction in the next 6 months, no further arterial intervention was needed until her death 6 months later after withdrawal of hemodialysis.