Carotid-brachial bypass and simultaneous radiocephalic fistula for a patient on hemodialysis. 
Patients undergoing long-term hemodialysis often suffer from obliterative arterial disease, which may lead to hand ischemia and/or access failure.  We present the case of a 54-year-old female patient with multiple failures in obtaining vascular access.  Computed tomography angiogram revealed a long occlusion of the axillary artery.  Vein mapping through duplex scanning demonstrated a suitable cephalic vein in the left forearm.  A left carotid-brachial bypass was performed with simultaneous radiocephalic arteriovenous fistula formation.  Immediate results were excellent, and the postoperative course was uneventful.  To our knowledge, this is the first report of such a combined approach.