Autologous arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis. After the first AVF of the cephalic vein and radial artery became unavailable, the vast majority of physicians in China turned to upper arm internal fistulae or even direct insertion of tunnel catheters with CUFF. Many opportunities for forearm endovascular fistulas were abandoned, and artificial vessels were not popular in China, resulting in high usage of deep vein catheters, increasing the chance of infection and affecting dialysis outcomes. Reasons for failure of AVF of cephalic vein and radial artery: 1. Unable to make: Vein vessels are too thin and branching; weak arterial pulsation; veins cannot be felt or traveled; veins are far from arteries; long-term injection vein sclerosis occlusion, etc. 2. Technical problems of vascular anastomosis: small incision end-lateral anastomosis or even end-to-end anastomosis is used to easily form anastomotic stenosis; veins are not expanded; veins are twisted or rotated; veins are too high tension. 3. Improper use of blood vessels: fixed point puncture; puncture damage to the intima. 4. Lesions of the vessel itself, prone to thickening and stenosis. Countermeasures according to the above reasons: 1. Preoperative examination: ultrasound observation of vessel location, internal diameter, course, branching, depth; observation of whether there is a filling vein after prolonging the tourniquet time; accurate drawing of the vessel alignment to be used. 2. Vessel selection: identify the cephalic vein originally not reached or considered too thin by ultrasound or prolonging the tourniquet time; anastomose the two thin cephalic vein branches with the radial artery respectively; make a double incision to put the The thick branch of the vein that travels outward is transferred to the medial side through a subcutaneous tunnel; a vein graft from another site is taken to replace the sclerotic or occluded vein; an AVF anastomosis is performed between the ulnar artery and the guillotine vein; if the ipsilateral artery is not suitable, the vein is separated to a sufficient length and anastomosed to the contralateral artery through a subcutaneous tunnel. 3. All branches of the free or transferred vein must be carefully ligated; it is recommended to establish an end-lateral anastomotic fistula by lateral anastomosis, and the final anastomosis should be between 0.5 and 1.0 cm; make full use of various markers and always pay attention to avoid angulation, twisting, rotation, and high tension of the vein, especially in the subcutaneous tunnel; care should be taken to preserve the original direction of blood flow in both ends of the free graft; try to avoid tunnels perpendicular to the long axis of the arm.4 , postoperative drawing to preserve the vascular alignment and anastomosis location, to guide nurses on the puncture angle and direction, and to protect the vessels. In conclusion: make full use of all available veins in the forearm to maximize the life span of hemodialysis patients.