Juxta-anastomotic stenosis is defined as stenosis that occurs within the section of the AVF that is immediately next to the artery anastomosis (within 2-3 cm). The lesion has the effect of obstructing AVF inflow. PE of the anastomosis and distal vein can easily identify this lesion (4,17,18). Duplex ultrasound may also be used to identify juxta-anastomotic lesions (19). CT angiography is the gold standard for identifying vascular abnormalities but cannot distinguish between inflammatory changes due to PVST and true neoplasm (20). MRI with gadolinium may show increased signal intensity on T1-weighted images and decreased signal intensity on T2-weighted images compared with the contralateral side (21). Patients with symptomatic juxta-anastomotic stenosis require treatment. Endovascular intervention using balloon angioplasty or stenting are effective treatments for juxta-anastomotic stenosis (22,23). Patients who are not candidates for endovascular therapy can undergo surgical revision of the anastomosis site (24,25).