Vascular complications of arterio-venous fistula construction for haemodialysis are rare. We report a patient who developed the hand venous hypertension syndrome with ulceration, 2 years after successful construction of a side-to-side radio-cephalic fistula at the wrist. The surgical treatment was ligation of the distended vein immediately distal to the fistula in the hand, and fistula function was preserved. The ulceration healed within 2 weeks of surgery. This complication had not been seen previously in the Dialysis Unit at Cardiff Royal Infirmary where, over the past 20 years, 800 fistulae have been constructed.