With the increasing incidence of chronic renal failure in China, the population of patients requiring hemodialysis is gradually becoming larger. A good dialysis access is the lifeline of patients, and arteriovenous endovascular fistula is the most commonly used vascular pathway, and endovascular stenosis is its most common complication and the most important cause of endovascular occlusion and eventual loss of function. However, there are some patients in the clinic who have a patent endovascular pathway, and due to central venous stenosis or obstruction, this leads to symptoms of swelling of the limb, which also affects the use of the endovascular pathway and has a serious impact on the patient. Cephalobrachial vein occlusion is a type of central venous obstruction, and due to the presence of the endovascular fistula, the venous pressure is high and the patient presents with swelling of the affected upper limb and face. In order to investigate the clinical manifestations and diagnosis and treatment of the combined cephalic and brachial venous occlusion after upper limb arteriovenous endovascular fistula in renal failure hemodialysis patients, we retrospectively analyzed the clinical data of 14 patients with combined cephalic and brachial venous occlusion after upper limb arteriovenous endovascular fistula admitted to the Second Hospital of Guangzhou Medical University from January 2011 to May 2014. 1. general data 8 cases in males and 6 cases in females, age 19-75 years old, average 58±13 years old, 6 cases on the left side and 8 cases on the right side. 14 patients showed swelling of the affected upper limbs, superficial varicose veins in the shoulder, chest and neck, subcutaneous capillary hyperplasia, and swelling of the affected side of the face. 12 cases were after autologous arteriovenous endovascular fistula, including 10 cases of forearm endovascular fistula and 2 cases of high endovascular fistula; 2 cases were after artificial endovascular The average time of fistula establishment (42.3±37.2 months), all cases were patent, some dialysis access varicose veins or aneurysmal dilatation. 11 patients had a history of central venous placement and 2 cases after renal transplantation. 2. Diagnosis: Patients were first examined by ultrasound in the outpatient clinic for internal fistula, blood flow velocity, jugular vein patency, and increased pressure in the punctured vein during dialysis. After admission, CTV or venography confirmed the diagnosis of cephalobrachial vein occlusion on the affected side, excluding cases of subclavian vein and superior vena cava stenosis or occlusion. 3.Treatment Two patients were post-transplantation, and the transplanted kidney functioned well, so they were treated with action-venous fistula closure, two patients were treated conservatively, and 10 patients underwent endovenous angioplasty of the head and arm veins, among which eight patients had stenting, and the swelling of the affected limbs and face was relieved or improved after treatment. 4, Discussion After the arteriovenous endovascular fistula of the upper extremity in renal failure hemodialysis patients, the pressure in the vein increases due to the unobstructed endovascular fistula and venous development, and if the way back to the heart is obstructed, it will certainly cause the swelling of the upper extremity, and the symptoms are more serious than those in patients with central venous occlusion after non-endovascular fistula because of the high blood flow pressure. Cephalothoracic vein occlusion is a type of central venous occlusion that causes swelling of the patient’s face because of the obstruction of the return of the internal jugular vein on the affected side. If the occlusion or stenosis is confined to the subclavian vein and the internal jugular and cephalic veins are not involved, then only the upper extremities are swollen and the face is usually asymptomatic. If the occluded segment involves the superior vena cava, the venous return to both upper extremities and the entire face will be affected and symptoms will appear. In patients with head and arm vein occlusion after endovascular fistula, superficial varicose veins and dilated subcutaneous capillaries appear in the upper extremities, shoulders, and even neck if the disease is of long duration. However, in some patients, because the patency of the central vein was not examined and evaluated before the fistula, due to the presence of stenosis or occlusion of the cephalobrachial vein, the patient developed swelling of the limbs and face immediately after the endovascular fistula. In one of our patients, the patient developed severe swelling of the affected limb and face after endovascular fistula of the forearm at an outside hospital, thus suggesting that the surgeon should not limit the assessment of the vasculature to the upper limb veins only and should not ignore the patency of the central veins before endovascular fistula. It is currently believed that the following factors contribute to the narrowing or occlusion of the head and arm veins: (1) history of central venous placement, repeated puncture, placement, inflammation, and other irritating factors that lead to intimal hyperplasia of the head and arm veins, or combined thrombosis, resulting in venous narrowing or occlusion. (2) Anatomical factors: The cephalic brachial vein is located in front of the aortic arch and its branches and behind the sternum, which is easily compressed. The left cephalothoracic vein crosses the innominate artery or the aortic arch and is compressed by the pulsating artery, resulting in luminal stenosis in about 26.7% of cases. (3) Hemodynamic factors: Due to the presence of endovascular fistula, the hemodynamics in the cephalic arm vein are altered, which can easily lead to intimal hyperplasia, platelet aggregation, and local thrombosis of the vein. Diagnostic options: In patients with endovascular fistula, the presence of swelling in the upper limbs and face of the operated side suggests the presence of venous hypertension, and the corresponding examination should be done as early as possible. Ultrasonography is influenced by the sternum, clavicle and lungs, and the stenosis or occlusion of the head and arm veins is not easy to diagnose. CT angiography provides a full picture of the endovascular and venous circuit, and has a visual representation of the relationship between the head and arm veins and the circumferential tissues, especially the compression, after 3D reconstruction. Venography is the method of choice for the diagnosis of such diseases, most often the vein punctured during dialysis is chosen because of its development, ease of puncture, ease of postoperative compression hemostasis, contrast reflux, and visualization of the obstructed site: the degree and extent of head and arm vein stenosis or occlusion is visible, and the peripheral collateral veins are open. Treatment choice: In this group of patients, there are 2 cases after renal transplantation and the transplanted kidney is functioning well without further hemodialysis, so the shutdown fistula procedure to reduce venous pressure should be the first choice, and the postoperative results showed that the patients’ symptoms improved significantly. For patients who still need dialysis, the internal fistula is their lifeline, so maintaining dialysis access is crucial for such patients, but the patient’s symptoms of swelling are severe and interfere with dialysis, so the ideal approach is to maintain the function of the internal fistula while relieving symptoms, and percutaneous transluminal angioplasty becomes the preferred modality to treat such patients. It can be dilated with a balloon first, and if the stenosis or occlusion is still retracted after dilatation, a stent can be placed. For endoluminal treatment, the interventional puncture can be performed in the upper limb internal fistula circuit vein, the femoral vein or the affected jugular vein. We choose the femoral vein access in cases where the diagnosis of CTV is clear, as the postoperative puncture site compression does not affect the subsequent or immediate use of the dialysis venous access. For patients without CTV, upper extremity internal fistula venipuncture angiography is feasible, and endovenous therapy is performed immediately after the diagnosis is clear.