The first is that the patient’s heart is not in the right place. If necessary, ultrasound should be used to check the vascular condition of the proposed endovascular surgery, so that we can have a good idea of the vascular condition before surgery and avoid looking for blood vessels everywhere during surgery. ③Patient preparation, 1 to 3 days before the proposed surgery, appropriate medication and dialysis treatment, so that the patient’s general condition improves significantly and can successfully withstand the surgery, and can also withstand the suspension of dialysis 1 to 3 days after the surgery. The surgical consent form should not be copied from the template, but must be modified on the basis of the template in conjunction with the patient’s specific condition to make it relevant to the patient’s reality, and the consent form should be read in full by the signatory or read in full by the doctor to the signatory, so that the signatory really knows the meaning and risks of the surgery. 2.Surgery notice: A second-line teacher’s signature is required before it can be sent to the operating room, otherwise it is regarded as an invalid notice. 3.Surgeon’s qualification: The participation of personnel with corresponding surgical qualification announced by the department is required before the relevant surgery can be performed. Otherwise, it is regarded as a violation of medical operation routine. 2. Intraoperative treatment standard 1. Patient’s position: the patient should be in a lying position with the upper limb abducted no more than 90°. 2. Patient’s anesthesia: 2% lidocaine local anesthesia. 3. Separation of vessels: a longitudinal incision of about 2 to 3 cm is made between the radial artery and the cephalic vein on the wrist line of the forearm. 4.Block the blood flow: place a vascular clip at the proximal end of the cephalic vein and radial artery, and ligate and cut the distal end obliquely. 5.Heparin saline flush the vessel: flush the proximal end and the lumen with 1% heparin saline. 6.Decision of anastomosis: If the artery has good elasticity, no stratification, and the internal diameter of the artery and vein is above 2.5 mm, titanium wheel nail action-venous endovascular anastomosis can be considered; if the artery is sclerotic, poor elasticity, stratification, or the internal diameter of the artery and vein is too small, 7-0 nylon thread should be used for continuous external full-layer suture. 7. The order of opening the vascular clamp: first release the vascular clamp at the venous end, cover the anastomosis with a gauze block, briefly release the vascular clamp at the arterial end, check the anastomosis for blood leakage, if there is blood leakage, press the gauze block for 1 to 2 minutes, if there is still blood leakage, add a stitch locally. 8. The order and principle of fusion: the skin should be sutured from the proximal end, and the skin should be lifted with tooth forceps for suturing to avoid damage to the vessels during suturing. 9. Wound dressing: Wrap the incision with ambrosia or gauze block, and do not wrap too tightly, which will compress the blood vessels and cause poor blood flow and thrombosis. Postoperative treatment specification 1, patient position: the patient should sleep in a lying position or to the non-operative side of the lateral position, the surgical side of the limb can be flat, avoid the surgical side of the lying position, avoid excessive bending of the surgical side of the limb, so as not to compress the surgical side of the upper limb veins, resulting in poor venous reflux, blood flow slowdown, the formation of venous thrombosis, blocking the internal fistula. Within 1 week after surgery, when the patient stands or walks, the anterior wall of the operated side can be suspended from the neck with a bandage to keep the anterior wall in a horizontal position to facilitate venous reflux and reduce the swelling of the forearm and hand on the endovascular side. 2, postoperative observation: observe the filling of the terminal vessels of the fingers on the side of the internal fistula, such as whether there is numbness, coldness, pain and other ischemic conditions in the fingers. Observe whether there is any hematoma at the anastomosis of the internal fistula and whether there is any local blood oozing. If more blood is found to be oozing or the arm on the side of the internal fistula is painful, report to the chief resident and notify the chief resident and surgeon for treatment. If the bleeding is dark red, it is mostly subcutaneous bleeding and can be given local sutures. If it is bright red and bleeding is heavy, it is mostly bleeding from the internal fistula suture and needs to be treated in the operating room. Observe whether the internal fistula vessels are open. First, touch the endovascular end of the fistula for tremor, or use a stethoscope to listen for a vascular murmur, if you can’t touch or hear the murmur, find out if the local dressing is too tight, so that the anastomosis and the venous side are compressed. It is forbidden to perform blood pressure measurement, intravenous injection, infusion, blood sampling, etc. in the arm on the side of the fistula to avoid occlusion. Avoid hemodialysis immediately after surgery. If blood is seeping after dialysis, give fisetin to neutralize heparin. 3. Postoperative education: inform the patient to keep the arm on the side of the fistula clean, prevent pressure on the arm on the side of the fistula, loose sleeves on the arm on the side of the fistula, and avoid lying on the side of the arm on the side of the fistula during sleep. The patient should be taught to determine the patency of the fistula by touching the fistula vein daily for tremors, if the tremors are felt, the fistula is patency, if not, the doctor should be notified immediately for treatment. The patient can be instructed to perform early functional exercises 1 week after surgery to promote early maturation of the endovascular fistula by squeezing a rubber exercise ball with the arm on the side of the endovascular fistula 3 to 4 times a day for 10 to 15 min each time. generally, maturation is considered when the vein is arterialized and the diameter of the endovascular fistula is thickened to ensure successful puncture and provide adequate blood flow. It is best to use it after 3 to 4 months after angioplasty.