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In this presentation I will demonstrate how to create Basilic vein transposition fistula, using the last generation LigaSure™ Device. We start with a brief presentation of the patient story, when he was 69-year-old with Diabetes mellitus, Hypertension, and end stage renal failure. At two thousand sixteen, he begins hemodialysis via permcath. One month later he came to us for vascular access creation. Unfortunately, he developed acute coronary syndrome, that required hospitalization. In February 2017, we scheduled him for the creation of left brachial cephalic fistula. He did well with the fistula with recurrent severe cephalic arch stenosis that required repeated angioplasty. Despite treatment prevention with Enoxaparin, the fistula suffered recurrent multiple stenosis and clots. Despite treatment prevention with Enoxaparin, the fistula suffered recurrent multiple stenosis and clots. Eventually At July 2022 we lost the fistula, nearly six years post operative and a new permcath was inserted. One month later we scheduled him on August 2022 for new right basilic vein transposition fistula. Planning new access, is a major step prior to any access surgery, using Duplex scan. The occluded fistula in the left arm was not suitable for fistula creation. In the right arm the brachial artery and the axillary vein are suitable for basilic vein. Prior to surgery, a venography took place, showing nice patent vein for new fistula. Our patient now is 74-year-old, on hemodialysis via permcath and replaced by a new right basilic vein transposition done at August 2022. At that step, you can now view how we create and maintain the new transposed vascular access, and how we follow up the high-quality detailed video. 6 years post failure of left brachial-cephalic fistula, a new superficial basilic vein transposition fistula creation for hemodialysis; Using the LigaSure™ Device. Background: Superficial Basilic Vein Transposition for Right Arteriovenous Fistula Creation, In the Upper Arm. Using: Modified Micro-Surgery Technique and the LigaSure™ Device. “I have no financial interests or relationships to disclose” Surgeon: David Shemesh Scrub nurse and assistant: Irina Avnilov Shaare Zedek Medical Center Jerusalem, ISRAEL.