For patients with poor venous conditions in the forearm, the available options for hemodialysis access usually include the following: endovascular fistula in the forearm, endovascular fistula in the upper arm, and autogenous arteriovenous fistula in the elbow, which can be chosen clinically according to the patient’s specific situation. Generally speaking, if the superficial veins (cephalic vein, noble vein) in the upper arm are superficial, easy to puncture and well filled, the priority of the autologous arteriovenous fistula at the elbow can be considered (the principle of priority of autologous endovascular fistula), and the specific anastomoses include: cephalic vein-brachial artery endovascular fistula, median forearm vein-brachial artery endovascular fistula, noble vein-brachial artery endovascular fistula, among which if the condition of median forearm vein is good, the priority should be forearm The median forearm vein should be preferred for anastomosis, because anastomosis in the median forearm vein has an advantage that both the valgus vein and the cephalic vein are available for puncture after surgery, and the puncture length is more sufficient. The following is a case of a median antebrachial vein-brachial artery endovascular fistula.