The establishment of arteriovenous endovascular fistula in patients with chronic renal failure is the primary condition to ensure the smooth progress of hemodialysis, so it is an important pathway to health for patients with renal failure and a lifeline for hemodialysis patients, and the good or bad function of the lifeline directly affects the survival time and quality of life of patients with chronic renal failure. A common method of arteriovenous endovascular fistula: 1, autologous arteriovenous endovascular fistula: mainly in the extremities, the commonly used anastomosis method for the upper extremity is end-to-end anastomosis or end-to-side anastomosis of the flexural artery and the cephalic vein, and the lower extremity is anastomosis of the posterior tibial artery with the saphenous vein. 2.Human cadaveric artery bypass arteriovenous internal phlegm: human cadaveric artery comes from fresh cadaver without infectious disease and atherosclerosis, the anastomosis method is radial artery stump of upper limb anastomosis with cephalic vein, noble vein and median elbow vein, brachial artery anastomosis with median elbow vein mostly adopts straight bridge or U-shaped bypass surgery, the anastomosis diameter is 0.4-1.2cm, femoral artery of lower limb and saphenous vein adopts U-shaped bypass end-lateral anastomosis. 3.Polytetrafluoroethylene artificial vessel bypass: use polytetrafluoroethylene artificial vessel (PTFE) with diameter of 6-8mm and length of 30-50cm. A U-shaped bypass is performed between the brachial artery and the elbow vein or the femoral artery and the saphenous vein (see attached figure) Vascular access is the lifeline of hemodialysis patients, and it is very important to do a good job of protecting the lifeline of dialysis patients! (a) Precautions for autologous arteriovenous fistula: 1. 24 hours after surgery you can try to start doing ball gripping exercises (grip and press a rubber ball with one hand for 5 seconds, then relax for 5 seconds for one time). It is recommended to do this 300-500 times a day and can be done in rounds. This will increase the blood flow to the fistula and help it to mature and expand; 2. Wait 1-4 weeks after surgery for the fistula to fully mature before puncturing it. Touch the fistula with your hand daily to check for “thrill” or use a stethoscope to check for a “bruit” sound. If these two symptoms diminish or disappear, seek immediate medical attention, as the sooner the obstruction is treated, the better. 4. Avoid injury to the arm on the side of the arteriovenous fistula (e.g., injections, blood draws, blood pressure measurements) or compression (wearing a watch, bracelet, pillow, etc.) that could affect the circulation of the fistula and cause an embolism. 5. After dialysis, the fistula wound should be kept dry to avoid infection. The gauze should be wrapped for 24 hours and removed after the puncture wound has healed, and a moderate amount of warm water should be applied to the arm of the fistula to promote blood circulation. 6. If the fistula is not large enough, do exercises such as holding a ball, lifting a dumbbell, holding a handle, or making a fist. 7.If the fistula is excessively enlarged, use an elastic sheath to apply moderate pressure to prevent cardiac discomfort due to excessive blood flow. 8.If the arm is swollen due to needle leakage, ice packs can be applied within 24 hours after dialysis (10-15 minutes per hour) to stop the bleeding and pain; and hot packs can be applied after 24 hours after dialysis to reduce the swelling. 9. Clothing should avoid tight cuffs (e.g. when rolling up the sleeves) to prevent compression of the fistula. It is recommended that the sleeve on the side of the fistula limb be equipped with a zipper. 10. Control the amount of water you drink and do not increase your weight between dialysis sessions by more than 5% of your dry weight to prevent a drop in blood pressure during dialysis, which could lead to fistula embolism. 11. Avoid smoking. 12, Pay attention to the warmth of the limb at the fistula to prevent the blood flow from slowing down due to excessive cold, which may cause fistula embolism. 13.After the daily hot compress, you can make a circular massage from the anastomosis in the direction of the blood vessels (not too hard), and the force can be increased when the blood vessels are not functioning well. 14. Maintain good personal hygiene habits and wash the skin outside the fistula with antibacterial soap before each dialysis session. 15. Avoid skin injuries and use iodine volts to wipe the skin when it is broken. 16.If the fistula is red, swollen or painful, it may be a symptom of infection and should be treated immediately by a doctor, not by self medication. 17.If you cut your hand accidentally and it bleeds a lot, you should use clean gauze to stop the bleeding by applying direct pressure to the wound and seek immediate medical attention. (B) Precautions for transplantation of arteriovenous fistulae (artificial vessels): 1. Transplantation of fistulae is usually used for those with poor vascular conditions, using artificial vessels as bridges to connect arteries and veins. It can be used two weeks after surgery when the swelling is gone. 2. If edema is present, the arm should be elevated (above the heart). If the swelling is severe, an elastic bandage can be applied to reduce the swelling. 3.Since the artificial blood vessel does not need to mature and become thicker, you may not do ball gripping exercise.