For patients with end-stage renal failure, hemodialysis is an important tool to maintain life, and good hemodialysis access is the “lifeline” to ensure that hemodialysis can be performed properly. Generally, dialysis access is chosen in the upper extremity. For example, the classic radial artery-cephalic vein endovascular fistuloplasty; in the case of poor forearm autologous vascularity, the brachial artery-artificial vessel-upper arm vein procedure can also be chosen to establish dialysis access. The upper limb dialysis access has the advantages of simple surgical operation and convenient dialysis operation, and is most commonly used. However, a small percentage of patients lose the opportunity to have dialysis access in the upper extremity due to stenosis and occlusion of the superior vena cava and subclavian vein, local soft tissue infection, scarring, or multiple surgeries. In such cases, the lower extremity becomes an important site of choice. The following is a surgical procedure to establish hemodialysis access in the lower extremity: lower thigh saphenous vein-superficial femoral artery autologous fistuloplasty. Pre-operative preparation: 1. Ultrasound examination of the superficial femoral artery and saphenous vein of the operated limb to clarify the patency of both lumen, the diameter of the saphenous vein above 3 mm, and the subcutaneous depth of the saphenous vein. 2. Other routine examinations. The procedure: take an exploratory incision of the superficial femoral artery in the lower thigh, cut the skin and subcutaneous fat, find the saphenous vein and free a section of about 5cm long for backup. The deep fascia was incised, the suture muscle was freed and retracted, and the superficial femoral artery was found below the suture muscle and a 3-cm long section was freed. After heparinization, the distal and proximal ends of the superficial femoral artery and the proximal end of the saphenous vein were blocked. The saphenous vein was cut at the distal end of the surgical incision, ligated distally, and flushed with heparin saline and moderately dilated proximally. The superficial femoral artery was dissected longitudinally for about 1 cm, and the arteriovenous pre-anastomosis was flushed and trimmed, and a saphenous vein-superficial femoral artery end-lateral anastomosis was performed. Surgical schematic:$ Surgical pictures (the first one is the surgical incision, the second one is after the vascular anastomosis is completed):$ 6 weeks after surgery, the access is mature and ready for use. It is important to note: If the patient has a lot of subcutaneous fat and the saphenous vein is located deeper. Difficulty in puncturing during dialysis can occur after surgery. In this case, it is necessary to extend the incision intraoperatively to free a long enough saphenous vein and to relocate the saphenous vein to a superficial subcutaneous location, usually 0.5 cm from the skin is more appropriate for easy touch and puncture. The more common method of establishing dialysis access in the lower extremity is the femoral artery-artificial vessel-saphenous vein procedure, which is prone to postoperative infection due to the need for artificial material; also, the long-term patency and duration of use of this access is limited due to the irreparable nature of the artificial material. The use of autologous saphenous vein to establish dialysis access to the lower extremities does not have these problems and the cost of the procedure is significantly reduced. It is a procedure worth promoting.