Angioaccess has become increasingly important to vascular surgeons as more patients with end stage renal disease[ESRD] are being supported by hemodialysis. Because of the rapid increase in the number of patients undergoing hemodialysis in recent years, it has become necessary to develope alternative vascular access procedures. During the period from December 1986 to December 1992, 290 cases of arteriovenous fistula and associated operations for hemodialysis were performed at Department of Thoracic & Cardiovascular Surgery, Seoul Paik Hospital, Inje University. They Consisited of 175 male and 115 female, ranging in age from 8 and 79 years. The procedure of first choice, the Brescia`s original radial artery-cephalic vein arteriovenous fistula was performed upon 219 patients. In many patients, the radial artery-cephalic vein fistula cannot be performed because of inadequate vein or failure of previous radial artery-cephalic vein fistula. The waiting time until initiation of venous puncture for the first hemodialysis session was 3 days. The second choice of angioaccess, using the brachiocephalic arteriovenous fistula and brachiobasilic arteriovenous fistula at antecubital fossa, ulnobasilic arteriovenous fistula, femorosaphenous arteriovenous fistula, and radiobasilic arteriovenous fistula with saphenous in situ routes, was obtained in 17, 7, 4, 2 and 1 patients. Interposition grafts, the third choice of angioaccess, were performed upon 2 patients. Twenty seven patients underwent revisions or thrombectomies. The purpose of this report is to review the technique of this procedure and discuss the longterm results.