The perforating vein to the brachial vein is identified and tied Brachial artery identified and arteriotomy is done After successful end of the perforating vein to the side of the artery anastomosis Results: During the study period a total of 53 Gracz elbow AVF were constructed which accounted for 10.9 % of all AVF and 30.4 % of all elbow AVF. Of all Gracz fistulae, left elbow was the site for 77.4 % cases. 51 patients had short term patency (96.2 %). Of these, 2 patients died within 3 months period and 4 were lost to follow up. Out of 47 patients available for follow up 43 patients met medium term patency criteria (91.4%). All but 2 AVFs were successfully cannulated 3 weeks after the surgery. One patient had delayed wound healing and one patient had limb edema during the follow up period. Conclusions: The Gracz elbow fistula has very good success rate. Such surgeries can be performed by the Nephrologists independently