Techniques in Vascular accesseral limb. However, there are occasions when the contralateral limb is also unable to perform the AVF due to venous or arterial deficiency (4, 5). case reportWe report a 53-year-old male patient with renal disease secondary grade V chronic glomerulonephritis. He began hemodialysis on 07/10/85 and underwent kidney transplant on 03/12/86. He returned to dialysis treatment on 15/03/94 for graft loss due to chronic rejection. Regarding vascular access, the patient had undergone five previous surgeries, two of which had not immediately functioned and the other three had a patency of 20 months, 57 months and 69 months, respectively.The last AVF performed was on 03/03/2000 and it evolved into a major aneurysm and presented thrombosis with consequent loss of its function on 15/09/2006. Dialysis treatment was maintained through a long-term catheter. The patient was referred for evaluation into the possibility of a new AVF. During clinical examination of the right upper limb, the absence of pulses in the brachial, radial and ulnar was noted. A requested angiographic study showed occlusion of the brachial artery in its proximal third with refilling of the distal portion of the brachial artery before the bifurcation (Figs. 1 and 2).Through venous clinical examination it was noted the presence of the vein basilica of good size and good length.