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"The patient had a previous brachial vein to brachial artery anastomosis created near the right antecubital region. The patient is brought in now for a planned second stage transposition fistula. A long incision was made in the right arm, and the brachial vein was dissected free from the antecubital region up to the axillary region. Branches were divided with clips and ties. We divided the vein from the previous anastomosis at the antecubital region and tunneled that through the superficial tunnel in the brachial artery that was dissected free. A venogram was then performed demonstrating no evidence of kinking or twisting of the brachial vein. An anastomosis was then performed to the brachial artery with running prolene suture in an end-to-side fashion. Clamps were released, hemostasis obtained, drain was placed, and the wound was closed."