Hemodialysis is one of the effective methods for treating chronic kidney failure, and good blood access is the key to ensure long-term smooth hemodialysis. Arteriovenous endovascular fistula is the vascular access established for long-term hemodialysis treatment, which is the “lifeline” to maintain hemodialysis patients. From March 2008 to December 2012, we performed upper limb arteriovenous fistula surgery on 40 patients with chronic renal failure and achieved good surgical results, which are reported below. 1. Data and methods 1. 1 General data: In this group, there were 40 cases, 23 males and 17 females, aged 40 to 75 years old, with an average of 52.5 years old. There were 21 cases of chronic nephritis, 10 cases of diabetic nephropathy, 4 cases of hypertensive nephropathy, and 5 cases of nephrotic syndrome. Among them, 34 cases of cephalic vein-radial artery end-lateral internal fistula were operated, 32 cases were successful and 2 cases failed; 6 cases of cephalic vein-brachial artery end-lateral internal fistula were performed, and the operation was successful. Preoperative examination of radial artery and ulnar artery blood supply (ALLEN test), as well as vascular ultrasound to understand the internal diameter and blood flow of radial artery, ulnar artery and palmar arch artery and proximal veins. 1.2 Surgical method: 34 cases of radial artery-cephalic vein internal fistula group, 32 cases were successfully operated. If the patient was the first time to perform this operation, the upper limb was abducted in the prone position (the national people are mostly right-handed, so the left hand was preferred for the first operation), 1% lidocaine was used for local anesthesia, and a transverse or longitudinal incision of 3-5 cm was made on the radial side of the forearm near the wrist; the radial artery and cephalic vein were revealed by freeing, and the proximal end of the cephalic vein was cut off after harpooning, and the distal end was ligated, and the proximal end of the cephalic vein was flushed with 1:1 heparin saline or expanded with appropriate saline filling, and the proximal end of the broken cephalic vein was trimmed The vein was obliquely cut; the distal and proximal ends of the radial artery were blocked, the arterial wall was incised 5-6 mm in general at the appropriate site, the proximal pug was briefly released to understand the arterial flow rate, the heparin saline flushed the incised vessel lumen; the vessel was anastomosed with 7 or 8-0 prolene thread “parachute” type end-lateral continuous suture, the last stitch was finished, the first release After the last stitch, first loosen the proximal radial artery pug to fill the vessel and exhaust and tie the knot, then loosen the distal pug of the cephalic vein and flexor artery in turn, check that the anastomosis is free of tension, the vessel is in good shape without distortion, and the tremor is good on palpation, and suture the incision after adequate hemostasis. The operation time is 40-100min. the patient is instructed to avoid lifting heavy objects and compression on the upper limb of the operated side, and the endovascular fistula is generally used for dialysis for not less than 4-6 weeks after the operation. In the cephalic vein-brachial artery endovascular fistula group, 6 patients were operated with the upper limb in the prone position and under local anesthesia with 1% lidocaine. 3-5 cm incision was made at the transverse elbow or at the projection between the biceps, the brachial artery and cephalic vein were freed and exposed, and the end-lateral anastomosis of the operated vessels was performed. Several postoperative precautions were basically the same as those for radial artery-cephalic vein end-lateral arteriovenous fistula, and the operation time was 60-120 min. 2. Results In this group of 40 patients, 34 cases of cephalic vein-radial artery end-lateral internal fistula were performed, 32 cases of successful surgery and 2 cases of failure. Among the 32 successful cases, there were 26 cases of left upper limb arteriovenous endovascular fistula and 6 cases of right upper limb arteriovenous endovascular fistula, and the failure of 2 patients was due to the poor vascular condition; 6 cases of brachial artery-cephalic vein endovascular fistula were successful. The swelling of the upper extremity on the side of the fistula appeared to varying degrees after surgery, and was more obvious in the brachiocephalic-head vein fistula group, and the swelling subsided significantly with elevation of the upper extremity and movement of the hand. No complications such as anastomotic stenosis, upper limb numbness, or upper limb ischemia occurred in the whole group. In the brachial artery-cephalic vein endovascular fistula group, two cases showed heart failure on the second day after surgery, and the main reason was the sudden increase in the volume of the return heart blood due to the thick lumen of the upper arm cephalic vein. 3. Discussion Dialysis vascular access should generally have the following basic characteristics: (1) easy to repeat the establishment of blood circulation; (2) blood flow can be gradually reduced to zero at the end of dialysis; (3) maintain long-term function without frequent surgical intervention; (4) no obvious complications; (5) can prevent infection. A well-functioning vascular access is a prerequisite for smooth hemodialysis and has a direct impact on morbidity and mortality, length of hospital stay and medical costs.Berscia and Cimino et al [1] invented reusable arteriovenous endovascular fistulas in 1966, which make hemodialysis safe and easy to perform and have the above-mentioned characteristics and have become the preferred long-term vascular access for maintenance hemodialysis patients [2]. Currently, the commonly used blood access is radial artery-capillary endovascular fistula, and there are various ways of vascular anastomosis for radial artery-capillary endovascular fistula: lateral-lateral anastomosis, modified lateral-lateral anastomosis, end-lateral anastomosis, and end-to-end anastomosis. Patients with chronic renal failure are often combined with hypertension, diabetes mellitus, hyperlipidemia and other underlying diseases, and most of them have unsatisfactory vascular conditions, the cephalic vein is often small or occluded, and the radial artery often has plaque formation or inner and outer membrane separation phenomenon. The end-lateral anastomosis of the radial artery-capital vein at the wrist is the most widely used [4], and for those who can no longer apply the radial artery-capital vein at the wrist after multiple surgeries have been performed, we have used the end-lateral endovascular fistula of the brachial artery-capital vein, which also achieved good surgical results. In order to ensure that the operation achieves the expected results, we have summarized several experiences: (1) preoperative control of underlying diseases such as cardiac insufficiency and malignant hypertension, full understanding of proximal trunk venous reflux, and avoiding ipsilateral trunk venous placement; (2) the operation should preferably be performed on the next day after hemodialysis, which can reduce the risk of cardio-cerebral complications due to high potassium, high creatinine, and high urea nitrogen in patients with chronic renal failure, and can also reduce (3) the surgical incision must be able to reveal the vessels well and not affect the basic daily life and activities of the patient; (4) the vessels should be fully freed 3-4 cm during surgery, the outer membrane of the severed end should be properly repaired so that the anastomosis is free of tension and distortion, and the proximal branches of the veins should be ligated to prevent swollen hand syndrome; (5) the diameter of the anastomosis should be appropriate to prevent insufficient blood flow in the fistula veins leading to However, the anastomosis is not the larger the better, most patients’ internal fistula vessels will gradually expand to a certain state and remain relatively stable after surgery, some patients with thicker vessels have larger anastomoses, which are good for short-term use, but long-term use can lead to high-output heart failure due to increased vascular fistulae and excessive blood flow. It has been reported in the literature that when the anastomotic caliber >8.0 mm, it is prone to congestive heart failure [5-6], and we master it within 6 mm; (6) the anastomosis should be trimmed into an oblique row of ports to increase the anastomotic area to compensate for the small diameter of the vessel; (7) the anastomosis should pay attention to the needle distance and margin, and the last stitch after suturing should first open the proximal arterial vessels to allow complete filling and exhaustion; (8) the postoperative patient’s After the arteriovenous endovascular surgery, patients should be reminded to protect the endovascular vessels and train the upper extremity to promote the early maturation of the endovascular vessels, which are required to be used for dialysis at least 4-6 weeks after surgery, while the compression of the puncture site should not be too long and too strong after the end of hemodialysis. In conclusion, upper extremity arteriovenous endovascular fistula is the classic endovascular fistuloplasty for maintenance hemodialysis because of its small trauma, good vascular condition and simple procedure. Compared with other arteriovenous fistulae, the radial artery-cephalic vein and brachial artery-cephalic vein end-lateral fistulae are more economical, simpler to perform, less demanding on microscopic instruments, and have better long-term results, which are suitable for primary hospitals.