A 78-year-old woman with “chronic renal insufficiency (uremic phase)” needed to establish an autologous artificial dialysis access, but the local hospital’s evaluation concluded that “poor vascular conditions” prevented the establishment of permanent vascular dialysis access to the forearm. Therefore, the old man came to our hospital after several changes, and I was lucky enough to see this “difficult case”. Advanced age, arteriosclerosis, peripheral veins damaged by multiple punctures or treatments, reduced vascular elasticity and increased brittleness, small lumen (or dormant); prone to “spasm” …… which is what we call “poor vascular poor condition”. But this patient brought a description that only systematically described “poor vascular condition”. Fortunately, our specialty was well equipped and we were able to do a full evaluation of this patient immediately. After the initial evaluation, we concluded that the establishment of autologous access was promising, but technically challenging. We presented these results and options to the patient and family, who expressed understanding and willingness to “work together”. During the surgery, we did find out how poor the “poor vascular condition” was (as shown in the picture): 1. the main trunk of the cephalic vein was occluded; 2. the radial artery had multiple sclerosis, but the pulsation and elasticity were still within the range of our small heart; 3. the branches of the cephalic vein were slender, and when they came into contact, they were like “mimosas “At this point, the dilemma in front of us was whether we should choose to change the dialysis access to another area or to establish access to this branch that might still have hope. We presented the problem to the patient and the family, who still insisted on showing strong confidence in our technique, which we felt was one of the red flags of “doctor-patient dispute”. However, we could not give up the best treatment option for the patient for our own peace of mind. Therefore, we chose to use this branch to establish access. Because of the thinness of the vessel, we had to use a thin suture and a “special” method to anastomose the vessel. The surgical result was, in the end, satisfactory. The intraoperative tremor of the venous end was also quite frightening. However, the biggest difference between dialysis and other surgeries is that while we know the results on the spot, we don’t know the success of the surgery until at least a month later. In other words, we have planted the seeds, but it will take some time for them to mature. After the surgery, we asked the patient to keep performing “fistula exercises”. There were many frightening events during this period. …… First, there was a “rumor” from the nurses in the dialysis unit of the local hospital that it was unsuccessful; later, there were questions from colleagues about the choice of the genus, who thought it was unlikely to mature; and then, there was the opinion of the doctors in the local hospital that it was “quite good”. But the patient and his family showed the same unwavering trust as always, and although in the first two months, the maturity was not perfect due to burnout on the exercise, the subsequent month of persistence finally allowed for successful hemodialysis of the forearm autologous vessels (as shown in the picture). This is attributed to our specialty’s usual full monitoring of the patient’s perioperative surgical outcome, as well as to the trust and noble level of awareness of the patient and his family. Patients and their families, indeed, can only cooperate better with the diagnosis and treatment when they have a full understanding of the disease and the doctor’s treatment plan for it.